# New Modifiers XE,XS,XP,XU



## cohela (Jan 12, 2015)

Has anyone started using the modifiers XE,XS,XP or XU? If so, because XS reads separate structure/organ would this be used instead of a 59 using these case scenerios?

A: Pt comes in for excision on the nose and cheek (which modifier XS or 59)

B: Pt comes in for excision on the left side of nose and right side of nose
(which modifier XS or 59)

Thanks


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## sfontenot (Jan 12, 2015)

Please remember that Medicare is the only payer that is recognizing these modifiers and they are informational only.  I would use it for A but not for B.  I believe  you would add those together for the excision as it's the same structure.


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## Lliza71 (Jan 12, 2015)

Morning,

I believe the below would be correct; SOMEONE CORRECT ME IF I'M NOT PLEASE! 

A: Pt comes in for excision on the nose and cheek (which modifier XS or 59) - FOR THIS EXAMPLE I'LL USE 2 MALIGNANT LESION EXCISIONS (NOSE & CHEEK, BOTH 1.5cm) - *11642, 11642-XS*
XS is used in place of 59

B: Pt comes in for excision on the left side of nose and right side of nose
(which modifier XS or 59) - SAME AS ABOVE BUT USING BENIGN LESION EXCISIONS, BOTH ON NOSE, ONE 1.5cm AND THE OTHER 2.5cm - 
*11442, 11443*
No modifier needed when using different codes due to size


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## Lliza71 (Jan 12, 2015)

sfontenot said:


> Please remember that Medicare is the only payer that is recognizing these modifiers and they are informational only. I would use it for A but not for B. I believe you would add those together for the excision as it's the same structure.


 

-Isn't the rule of thumb that with excisions, you code each one separately, but with repairs you would add the sizes?  
I thought I remembered that from whenever I did these last, but it's been a while so...


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## mitchellde (Jan 12, 2015)

Lliza71 said:


> Morning,
> 
> I believe the below would be correct; SOMEONE CORRECT ME IF I'M NOT PLEASE!
> 
> ...


I agree you would use the XS modifier for all payers that are accepting this modifier.  Some of the commercials do.  Also it would be used in both scenarios.  You never add excision sizes together, that is only done for laceration repairs.  And even if they are different sizes but in the same region you still need a modifier to keep,the smaller from bundling with the larger.


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## mlthom (Jan 22, 2015)

When coding the flu A and B test - we use 87804 and 87804-59 mod??  I have noticed that medicare is denying the second test??  Is this because we are not using the "X" modifiers - if so which one should be used??


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## CatchTheWind (Jan 22, 2015)

I would suggest posting this question on the pathology and clinical lab forum.

But I can tell you that Medicare does not yet require the X modifiers. They give you a choice of whether to use modifier 59 or the X modifiers.


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