The information provided here applies to Medicare coding. Be sure to check with your Medicare Administrative Contractor (MAC) for additional information and clarification on these and other items. You should also contact your local insurance carriers to determine if private insurers follow Medicare's lead on all coding matters.
Four New Coding Modifiers Introduced
Many physicians use coding modifiers such as 25 for significant, separately identifiable evaluation and management (E/M) services. While modifier 59 is lesser known, it has been valuable in billing for a distinct procedural service independent from other non-E/M services performed on the same day. It allows for the “un-bundling” of services that are normally considered component parts of a service or procedure. There are, however, some changes that have taken effect on January 1.
The Centers for Medicare and Medicaid Services (CMS) introduced four new modifiers for increased reporting specificity where modifier 59 was previously used. They are as follow:
• XE – Procedure done during a separate encounter
• XP – Procedure done by a separate practitioner
• XS – Procedure done on a separate structure
• XU – Procedure for an unusual service that does not overlap with the main service
An Office of Inspector General (OIG) study found that 40 percent of modifier 59 services billed were paid inappropriately. As a result, CMS has released these new, more distinct modifiers that require more specific documentation. Each modifier has nuances and if providers understand this, the minor changes to their documentation needed will give them confidence in coding and billing correctly using these new modifiers. Additional information is available through CMS and your local Medicare Administrative Contractor (MAC).