On January 5, 2015, Centers for Medicare & Medicaid Services (“CMS”) implemented new rules for Modifier 59 to define subsets of the modifier and specification for their usage. Specifically, as of this date, Modifier 59 should not be used when a more descriptive modifier is available. The more-descriptive modifiers are the new modifiers XE, XS, XP and XU, which are described below.
XE should be used for separate encounters on the same date of service.
• For example: One surgery procedure at 6 a.m. and another at 6 p.m.
XP should be used for separate practitioners, same date of service (may or may not be the same encounter and may or may not be different specialties, but both practitioners fall under the same TIN).
• For example: Patient is under treatment for breast cancer. During her appointment, she is seen by two physicians in the practice – the Medical Oncologist and the Radiation Oncologist.
XS should be used for a separate structure or organ, or separate anatomical site during the same encounter.
• For example, an injection into tendon sheath (elbow) and injection into the tendon sheath (knee).
XU should be used for the same encounter, same practitioner and same anatomical site, structure or organ.
• For example, a diagnostic procedure is performed. Based on the findings, a therapeutic and/or surgical procedure is required on the same day (i.e., diagnostic cardiac catheterization is followed by a medically necessary cardiac procedure).
Please note the 59 modifier should not be used in conjunction with one of the new “X” modifiers. In addition, documentation must support the use of these modifiers and medical records may be requested by the payer to validate their use.
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