Ophthalmology and Optometry Coding Alert

Although CMS has clarified its regulations for when you can report modifier 59 (Distinct procedural service), that doesn’t mean you always should append it when reporting codes together that are typically bundled under the Correct Coding Initiative.

In some cases, other modifiers may be more appropriate, and in those situations, you should report these modifiers instead of 59. Alternative modifiers may include the following, among others, depending on the circumstances and depending on payer preference:

Modifier XE -- Separate encounter
Modifier XS -- Separate structure
Modifier XP -- Separate practitioner
Modifier XU -- Unusual Non-Overlapping Service
Modifier 25 -- Significant, separately identifiable evaluation and management service by the same physician or other qualified health care professional on the same day of the procedure or other service
Modifier LT-- Left side
Modifier RT-- Right side
Modifier 57 -- Decision for surgery