Health Information Management

Tip: Apply CMS’ new -X{EPSU} modifiers

APCs Insider, May 15, 2015

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Providers have asked many questions about how to use the –X{EPSU} modifiers due to a lack of guidance. CMS introduced the new modifiers last year as replacements for modifier -59 (distinct procedural service). Consider the following example for applying one of these new modifiers.
A patient receives an outpatient infusion of antibiotics at 8 a.m., leaves the facility, and returns at 8 p.m. for another infusion of the antibiotics.
The coder reports CPT® code 96365 (intravenous infusion, for therapy, prophylaxis, or diagnosis [specify substance or drug]; initial, up to 1 hour) for each visit.
Which –X {EPSU} modifier could be applied?
Since these visits would denote separate encounters, coders could append modifier –XE (a service that is distinct because it occurred during a separate encounter) to the second line item. Providers should check with their MACs regarding specific guidance about the modifiers as the industry waits for further information from CMS.
This tip is adapted from “Apply CMS' new -X{EPSU} modifiers" in the May issue of Briefings on APCs.

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