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Modifier XE

Separate Encounter: A service that is distinct because it occurred during a separate encounter.

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Modifier XP

Separate Practitioner: A service that is distinct because it was performed by a different practitioner.

Modifier XS

Separate Structure: A service that is distinct because it was performed on a separate organ/structure.

Modifier XU

Unusual Non-Overlapping Service: The use of a service that is distinct because it does not overlap the usual components of the main service.

What is Modifier 59?

Modifier 59 is used khổng lồ define a “Distinct Procedural Service.” These are procedures and services performed by a healthcare provider that are not typically reported together, but are appropriate and separately billable given the circumstances.

When modifier 59 is appended to lớn a CPT code, it indicates that the service is separate & distinct from another service with which it would usually be bundled. The modifier allows the clayên lớn pass Medicare bundling edits, resulting in additional reimbursement for the physician. Modifier 59 can be used to indicate a variety of situations including:

• Different encounters;

• Different anatomic sites; and

• Distinct services.

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It’s also important khổng lồ remember that modifier 59 should not be attached to lớn an E/M service.

Why New Modifiers?

Modifier 59 is not only the most used modifier, but it’s also the most abused. And while the abuse may be unintentional at times, the improper coding leads to incorrectly paid claims. As audits have sầu increased, CMS has realized that more specific modifiers may be helpful in deterring this abuse.

The -XEPSU modifiers are essentially a subphối of modifier 59. CMS believes their usage will help reduce overpayment errors.

How to lớn Use the –XEPSU Modifiers

Modifier 59 is not going away và will continueto lớn be avalid modifier, according toMedicare. However, modifier 59 should NOTbe used when a more appropriate modifier, like a XE, XPhường, XS or XUmodifier, is available. Certain codes that are prone to incorrect billing may also require one of the new modifiers.

CMS is encouraging providers khổng lồ adopt the modifiers quickly; they may be used by Medicare& considered valid even before national edits are in place on January 1st.