Neurosurgery Coding Alert

CMS introduces new options for some situations in 2015.

You have been heavily relying upon Modifier 59 when your provider performs multiple services during an encounter. Though you can still use the modifier, you will have to be careful when new “X” modifiers will be introduced in 2015. These modifiers will define the rationale of the distinct service. Here is what you need to know about the use of modifier 59 and “X” modifiers.

What’s happening: CMS faces multiple issues when dealing with claims reporting modifier 59 (Distinct procedural service). The agency is attempting to solve those issues by introducing four new “X” modifiers that will replace modifier 59 in some instances. These “X” modifiers are the following:

• XE: Separate encounter (A service that is distinct because it occurred during a separate encounter)
• XS: Separate structure (A service that is distinct because it was performed on a separate organ/structure)
• XP: Separate practitioner (A service that is distinct because it was performed by a different practitioner)
• XU: Unusual non-overlapping service (The use of a service that is distinct because it does not overlap usual components of the main service). 

CMS announced the change in Transmittal R1422, issued on Aug. 15. Read on for their reasoning and what it might mean for your practice. 

“While modifier 59 is intended by CPT® to be applied to procedures which are typically considered inclusive with another procedure but for certain reasons (e.g., different anatomical site, procedure performed at a different physical location) should be considered as a separate service, the modifier has been used inaccurately to circumvent the National Correct Coding Initiative (CCI) edits,” says Gregory Przybylski, MD, director of neurosurgery at the New Jersey Neuroscience Institute, JFK Medical Center, Edison.

Editor’s note: Read more about modifier 59 use in the next issue of Neurosurgery Coding Alert Vol 16 n1.