# new X modifiers



## bennieyoung (Jan 26, 2015)

Does anyone know which modifier would apply if one doctor did the Cath and a different doctor in the same practice did the Stent same day? I'm torn between the XP and the XU. I have read on here that it's suggested to use the XU with a diagnostic Cath when Stent is done same day same doctor. I'm not sure which one to use when it's different doctors. Any suggestions?


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## rebec26@juno.com (Jan 26, 2015)

We only use a modifier when it's the same physician performing both. Thanks!


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## sdblackbu (Jan 26, 2015)

Hi

Please note that BCBSNC has just updated with some information about x modifiers


Blue Cross and Blue Shield of NC provider.communication@bcbsnc-mail.com


Hope this helps

Susan B


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## mdm58 (Jan 27, 2015)

*X modifiers*

Right now I am still using the 59 modifier on the cath. until I get a rejection. I have checked CMS web site and it is still unclear as when to use the x modifiers. we are doing a webinar next month Just on the X modifiers.


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## mitchellde (Jan 27, 2015)

bennieyoung said:


> Does anyone know which modifier would apply if one doctor did the Cath and a different doctor in the same practice did the Stent same day? I'm torn between the XP and the XU. I have read on here that it's suggested to use the XU with a diagnostic Cath when Stent is done same day same doctor. I'm not sure which one to use when it's different doctors. Any suggestions?



Why did two different doctors get involved in this?  When a diagnostic cat hand stent of same artery is performed the. You cannot bill both.  The XU is not appropriate as these procedures do overlap each other.  But the question is why would one perform the cath and the other the stent placement?


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## rebec26@juno.com (Jan 27, 2015)

It is not uncommon for 1 physician to do cath and another to do pci. In that scenario we use XU. Thanks!


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## rebec26@juno.com (Jan 27, 2015)

I'm sorry I worded that wrong. If 2 diff physicians are involved we do not add a modifier. If 1 physician performs cath and pci we add the XU modifier. Thanks!


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## mitchellde (Jan 27, 2015)

rebec26@juno.com said:


> I'm sorry I worded that wrong. If 2 diff physicians are involved we do not add a modifier. If 1 physician performs cath and pci we add the XU modifier. Thanks!



You would not use the XU modifier if you are reforming stent insertion of the same artery(s) that you performed the cath on.  
XU Unusual Non-Overlapping Service, The Use Of A Service That Is Distinct Because It Does Not Overlap Usual Components Of The Main Service.
The stent insertion does overlap the components of the cath.  This is not acceptable usage for this modifier.  
I have never had a cath and stent performed by two different physicians.  The question becomes one of why is that medically indicated?


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## bennieyoung (Jan 27, 2015)

In our practice we have interventional and non-interventional doctors.  If a non-interventional does a diagnostic Cath and the patient needs stents one of our interventional doctors is called to do the stent.


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## bennieyoung (Jan 27, 2015)

So, now my question is have I been coding incorrectly by adding the 59 / X modifier to the Cath when a Cath and stent was done?


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## rebec26@juno.com (Jan 27, 2015)

I'm not 100% sure on usage of the new modifiers, but I have read several articles stating that XU is correct with a cath/pci. You could check out ZHEALTH as Dr Z stated XU would be correct. I'm not sure if you need the modifier if 2 diff physicians perform, but we do not use 1 and have not had any issues. Thanks!


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## mitchellde (Jan 27, 2015)

You would not bill both if performed by the same provider, so there will be no modifier. If two different providers are involved there is no modifier as well.  If both providers are in the same practice and credentialed as the same specialty the payer may not pay both claims.
ZHEALTH  may have stated to use the XU but clearly this does not meet the parameters of that modifier.


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## rebec26@juno.com (Jan 28, 2015)

Thanks for the insight.

The AMA, via CPT Assistant (April 2005), indicates that you may report a true diagnostic catheterization in addition to the therapeutic procedures described by 92980 and 92982: ?These two distinct procedures (diagnostic catheterization and therapeutic procedures), therefore, should be reported separately when performed at the same session or on the same day at a different session.?
***

When the cardiologist does perform a distinct 93454-93461 diagnostic service on the same date as a cardiovascular therapeutic service, you should append modifier 59 (Distinct procedural service) to the diagnostic code, advises Christina Neighbors, MA, CPC, CCC, ACS-CA, charge capture reconciliation specialist and coder at St. Joseph Heart & Vascular Center in Tacoma, Wash. You also may need to append modifier 51 (Multiple procedures


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## PamLeslie (Jan 28, 2015)

Often times the physician doing the diagnostic portion does not have interventional training therefore they bring in their interventionalist to deploy stents.


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## morganingle (Jan 28, 2015)

we have cath and stents done by different providers on the same dos-we code the cath with a 59 mod when a stent is performed and now a xu modifier.


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