Health Information Management

CMS seeking modifier -59 information from providers

APCs Insider, February 20, 2015

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By Steven Andrews
The latest guidance from CMS on modifier -59 (distinct procedural service) did little to help providers struggling with how to report the new -X {EPSU} modifiers. Before CMS releases more guidance, however, the agency is asking providers for additional information.
CMS is continuing to develop the policy on how the new modifiers will be used, but wants provider input to create the most helpful modifiers for them, according to Dr. William Rogers, director of CMS' Physicians Regulatory Issues Team.
"The problem is that we want to make sure before [the policy is] in stone that it's optimally described," he said during a recent Physicians, Nurses and Allied Health Professionals Open Door Forum. "We're actually more interested in getting your input than telling you how it will work at the moment."
Rogers asked providers to continue to send in examples of how they would use the new modifiers and what questions they may have about using them with specific procedures.
A caller noted that guidance released by two MACs, Novitas and WPS, on how to report the new modifiers appears to conflict, leaving providers even more confused. Rogers encouraged providers to also send in examples of MAC guidance that is confusing to help CMS craft specific guidance.
CMS is also planning to discuss the –X {EPSU} modifiers and its latest guidance on continued use of modifier -59 at a Hospital Open Door Forum at 2 p.m. (Eastern) Tuesday, February 24.
Providers should continue to send its questions, concerns, and examples regarding the new modifiers to

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