# Modifiers XU and XS



## jcasteel2 (Nov 1, 2016)

I'm hoping somebody can help us. We're a general surgery office and it's common for us to remove suspicious masses (lipomas, cysts, etc) and typically more than one. We frequently run into using the same code because although it's the same code we may have 5 masses to remove. We follow the Mutually Exclusive List but Medicare (and really all insurance) is giving us a hard time trying to use our modifiers XU and XS. We even tried to just bill them as units. Has anybody had this happen to them? Does anybody know of any rules that differentiate when and what to use? I appreciate any help anybody can offer!


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## thomas7331 (Nov 2, 2016)

I have not run into any problems with this - though, I'm not sure what exactly you mean when you say they're giving you a 'hard time'?  

The surgical codes, unless they're add-on codes, should always be billed with one unit per line, never combined in units.  Make sure you're putting the modifier on the correct code - it should go on the code in column 2 of the NCCI table if the codes are paired as mutually exclusive or incidental.  XS is the modifier I would use for procedures done at separate sites but you might need to check with your specific payers for their guidelines on this.  I avoid using XU unless the documentation supports that something unusual was done - XS is more appropriate in this situation.  59, not XU, should be the default modifier if no better modifier applies.  

Of course payers make errors too, so it might not be anything you're doing.  If you have some specific examples of denials, it might be helpful for giving you more information.


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## jcasteel2 (Nov 2, 2016)

Thank you so much for taking the time to respond to this! The first time we billed it, we billed it as:  25071-RT. 25075-RT-2UNITS. 24075-RT-4UNITS. 24071-RT. 25071-LT. 24075-LT-3UNITS. 25075-LT. 24071-LT-2UNITS. If we do not use units, it's the same anatomical site I would assume we would use XU. But they keep denying as duplicates. Can you use XS if you remove 5 separate lipomas from the right forearm? I should also note that we have previously tried billing these removals using XS and they would deny for the same reason "duplicates". That's why we tried units this time, and they're still being denied. Can we still use 59???? Cause that would make it a lot easier lol. We feel like we have no idea what they want and we don't have a lot of resources on this.


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## thomas7331 (Nov 4, 2016)

XS is defined as 'separate structure', not different anatomical location.  In my opinion, two different lipomas are two different structures, even if in the same body part.  But some coders/payers may have different guidelines - if so, I'd use 59 as the alternative.  Some payers may prefer modifier 76 instead of 59 for the repeated codes.  

I would have billed each of these with one unit on separate lines, with the modifier on the additional lines that are repeated.  With this many codes repeated on one claim, you will often run into payment problems, especially if the claim gets split or duplicated during processing, as the payer can't really easily tell which are duplicates and which are not.  I've find you often just have to call and try to explain it over the phone or submit the op notes and attach a letter explaining to them exactly how they should have paid this.


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## jkyles@decisionhealth.com (Nov 5, 2016)

*You may still use 59*

Last year a Medicare official said people may use the X modifiers _if_ they want, but if they're unclear on how to use them, they should stick with 59. He also said that if someone uses an X modifier incorrectly and is later audited, the provider would still have to refund the money. 

However, you should check with your MAC/payer because some are starting to ask for 76 in place of 59. In addition, I would check on its policy for LT/RT. Some only want 50 when it is appropriate.


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