Health Information Management

Tip: Review CMS’ four new subsets of modifier -59

APCs Insider, November 7, 2014

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CMS hopes to gain a better understanding of when and why providers use modifier -59 (distinct procedural service) by introducing the following four new modifiers, announced in Transmittal 1422:
  • -XE, separate encounter, a service that is distinct because it occurred during a separate encounter
  • -XS, separate structure, a service that is distinct because it was performed on a separate organ/structure
  • -XP, separate practitioner, a service that is distinct because it was performed by a different practitioner
  • -XU, unusual non-overlapping service, the use of a service that is distinct because it does not overlap usual components of the main service
The agency wants to track exactly how organizations have been using modifier -59. Starting next year when providers begin using these new modifiers, the agency will be able to see the basis for their use. CMS will likely also begin to create even more specific edits around which modifiers can go with which codes.
 
For more information, join Jillian Harrington, MHA, CPC, CPC-I, CPC-P, CCS, CCS-P, MHP, on Thursday, November 13, at 1 p.m. (Eastern) for HCPro's webcast Modifier -59: Explain the Changes for 2015.
 
This tip is adapted from “CMS introduces four new subsets of modifier -59” in the November issue of Briefings on APCs.



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