On January 5, 2015, Medicare and private pay claims submission should start to include the use of the New 59 subset modifiers. There will be a grace period of introduction, but each office should be aware of the changes and start the implementation process as soon as possible.
Remember that providers must maintain adequate documentation in the medical record to support the use of modifier 59 for distinct services. Please contact us with any questions you may have regarding proper use of the new subset modifiers or properly documenting services.
Modifiers XE, XS, XP, XU are effective January 1, 2015.
These modifiers were developed to provide greater reporting specificity in situations where modifier 59 was previously reported and may be utilized in lieu of modifier 59 whenever possible. **(Modifier 59 should only be utilized if no other more specific modifier is appropriate.)
Although NCCI will eventually require use of these modifiers rather than modifier 59 with certain edits, providers may begin using them for claims with dates of service on or after January 1, 2015.
The modifiers are defined as follows:
XE – “Separate encounter, A service that is distinct because it occurred during a separate encounter” This modifier should only be used to describe separate encounters on the same date of service.
XS – “Separate Structure, A service that is distinct because it was performed on a separate organ/structure”
XP – “Separate Practitioner, A service that is distinct because it was performed by a different practitioner”
XU – “Unusual Non-Overlapping Service, The use of a service that is distinct because it does not overlap usual components of the main service”
More information from cms.gov:
http://www.cms.gov/Medicare/Coding/NationalCorrectCodInitEd/downloads/mo difier59.pdf
Remember that providers must maintain adequate documentation in the medical record to support the use of modifier 59 for distinct services.
Please contact us with any questions you may have regarding proper use of the new subset modifiers or properly documenting services.