Making your distinct separate procedural coding more specific will strengthen your claims.
There is help out there for you while you wait for more clarification from CMS on when to use the X{EPSU} modifiers. Payers are publishing their instructions orproviding you with online direction.
Getting a glimpse at payers’ examples of when each modifier applies will helpyou submit successful claims. In this second part of our two-part series on the X modifiers, review guidance from three more payers to help you learn when to use each of the four new modifiers.
Review the X Modifier Background
You have been waiting for more instruction, since the CMS introduction of thefollowing four new modifiers on Aug. 15, 2014:
While you wait, check to see if your payers have published their policies for using X{EPSU}.
“Having guidelines for these will certainly be helpful,” says Suzan (Berman)Hauptman, MPM, CPC, CEMC, CEDC, director of coding operations at Allegheny Health Network in Pittsburgh, Pa. “However, as the provider community starts to usethem, the payers will learn how the modifiers have been interpreted by the providers.They can then target the guidelines so that we all know how and when to use them.”
See Available Instruction
You know the purpose of modifier 59 (Distinct procedural services) is to identifyprocedures or services (other than E/M) that you normally do not report together.You also know that CMS and some private payers want you to use the newmodifiers when appropriate but they will still recognize 59. You will need to diginto each payer’s policy to know exactly when and how to use the four new Xmodifiers. Take a look at what some payers are telling you to do.
United Healthcare: UHC, a network that provides healthcare plans across thecountry, is following CMS by continuing to use modifier 59 when no other more descriptive modifier is available.
Instructions from UHC show you which of the four Xmodifiers you should use with certain types of billingsituations, as follows:
Resource: Refer to www.tinyurl.com/p35g87m fo rmore information about how UHC wants you to use the X{EPSU} modifiers.
Tufts Health Plan: Tufts Health Plan, a healthcare plan in Massachusetts and Rhode Island, published a policy similar to CMS’s. The guidance states that Tufts will continue to accept 59 or the new X modifiers for claims with dates of service on or after Jan. 1, 2015. The reimbursement for claims with one of the four X modifiers will be the same as if the practice had billed with modifier 59.
Resource: Refer to www.tinyurl.com/oyxawsn for more information.
Novitas: In its policy, Novitas, a Medicare Administrative Contractors (MAC) doing business in the southern and northeast parts of the country, provides examples from CMS with its own suggestions for the use of XE, XS, and XU only. They accept XP, but they don’t provide an example for XP. The examples are:
Resource: Refer to www.tinyurl.com/nsrf56e for the complete policy.