PCG Software (PCG), a leading provider of software solutions designed to slow the escalating costs of healthcare, today announced the public release of a new primer document designed to provide guidance on the four new Healthcare Common Procedure Coding System (HCPCS) modifiers to define subsets of modifier 59 that The Centers for Medicare & Medicaid Services (CMS) established.
The educational resource, “A Primer on the Coding Modifier 59 Subset: XE, XP, XS and XU,” offers insight and tips into how to use each of the new modifiers that became effective January 1, 2015 and 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 is the most commonly used and abused modifier for Medicare reimbursement of CPT codes in acupuncture, breast biopsies, physical therapy, radiology, surgery and other medical practices. It often causes incorrect payments – triggering audits, fraud, waste and abuse (FWA) cases and escalating costs for everyone,” said Andria Jacobs, RN, MS, CEN, CPHQ, chief operating officer of PCG Software. “The new codes were designed to be more descriptive, precise and reduce errors, but because there hasn’t been clear guidance issued on how to use the new modifiers, the change has caused denied claims, increased costs and frustrated the industry more than necessary. So we felt it incredibly necessary to develop and release this primer document to the industry, as we continue on our mission of reducing the cost of healthcare.”
Modifier 59 has been used to identify procedures/services that are commonly bundled together but are appropriate to report separately under some circumstances, whereas the XE (Separate Encounter), XP (Separate Practitioner), XS (Separate Structure) and XU (Unusual Non-Overlapping Service) may now be used, together with National Correct Coding Initiative (NCCI) edits, to identify distinct services in the same encounter warranting separate reimbursement. While it encourages migration to the new modifiers, CMS currently allows providers to submit either modifier 59 or the appropriate X modifier to override Correct Coding Initiative (CCI) edits and get paid.