Distinguish Between Modifier XS and 59 Use for Separate Procedures
Question: I have a report that documents one of our gastroenterologists performed a screening colonoscopy that turned therapeutic. The patient’s insurance requires modifier PT for the procedure, but I’m unsure if I should then use XS or 59 for the removal techniques of two polyps. My manager has instructed us to use PT/XS for Medicare and PT/59 for commercial payers. What is the correct combination of modifiers? Virginia Subscriber Answer: Modifiers 59 (Distinct procedural service) and XS (Separate structure, a service that is distinct because it was performed on a separate organ/structure) are essentially one in the same. Choosing one to append to your procedure codes comes down to preference — some payers and supervisors prefer XS while others may opt for 59. As long as you apply the modifier correctly, the claim should be approved. Most commercial payers tend to follow Medicare’s lead, so XS can be the default choice unless a denial occurs. In that case, you could switch to 59 and resubmit the claim. Medicare prefers the X{EPSU} modifiers, and coders and billers have noticed that commercial payers are more likely to pay with the X{EPSU} modifiers since the descriptors provide greater specificity than modifier 59 on the procedure code. Revenue Cycle Insider gathered a couple of tips to help your staff determine which modifier to use for separate procedures: Tip 1: Track claim denials for modifiers XS and 59 to see which modifiers receive denials and which payers deny the claims. Tip 2: Make a cheat sheet of which payers prefer which modifier. For example, if payer 1 wants you to use modifier 59 and payer 2 wants you to use modifier XS, mark that down. Print off the sheet and post it in your billing department, so coders and billers can easily reference it during the workday. Mike Shaughnessy, BA, CPC, Development Editor, AAPC
