Otolaryngology Coding Alert

Here’s why your use of these modifiers will be rare.

While CPT^® still has modifier 59 (Distinct procedural service) on the books, some insurers are asking coders to use the more specific X{EPSU} modifiers in place of 59.

Quick rundown: The most commonly used X{EPSU} modifiers are XS (Separate structure) and XE (Separate encounter). There are two other X modifiers, however: XP (Separate practitioner) and XU (Unusual non-overlapping service). And if you haven’t used these modifiers much, you’re not alone.

Encounters that you’ll code with modifiers XP and XU “will be very infrequently seen,” relays Barbara J. Cobuzzi, MBA, CPC, CENTC, COC, CPC-P, CPC-I, CPCO, AAPC Fellow, Vice President at Stark Coding & Consulting, LLC, in Shrewsbury, N.J. “If you find yourself using the XP and XU modifiers often, you may want to reconsider the usage as this will set off a red flag.”

If you do come across an XP or XU scenario, however, you need to recognize it. Check out some choice advice from Cobuzzi, which helps illustrate when you might need to use XP or XU.

2 Physicians Mark XP Encounters

A modifier XP scenario “usually involves one surgeon who does one stage of the surgery and another who performs a second stage, where the two stages would be considered bundled,” explains Cobuzzi.

“This may be encountered during a cancer or trauma when two physicians from the same practice are providing service to a patient which may be considered bundled services, but because the two services were provided by two different physicians because they have different subspecialties, the services are each separately payable via the XP modifier,” Cobuzzi continues.

Use XU Sparingly

The XU modifier should be the least-used modifier option, Cobuzzi says. Modifier XU situations “represent the real exception that is most rarely encountered, and if this modifier is used more than one or two times a year, it is probably being used too much.”

For otolaryngology practices, an XU encounter might occur when “an otolaryngologist performs both a nasal endoscopy and a flexible laryngoscopy (using different scopes for each diagnostic procedure) and due to unusual circumstances,” Cobuzzi says. Though payers would normally bundle these procedures under the endoscopy code, there are rare instances when you can unbundle these codes.

“So, if the doctor documents justification and documents the medical necessity for needing two different scopes, one that will only work to examine the nasal cavity and sinuses and the other will only work to examine the nasopharynx, oropharynx and larynx, then both codes can be coded and billed,” Cobuzzi says.

Note: If provider performed two “timed” services during the same encounter, but provided those services sequentially. If the payer wants an X modifier, choose XU.

Rationale: “These two scopes are bundled together because it is felt that a nasal endoscopy and a laryngoscopy can be performed by the same instrument. However, it is acknowledged that there are circumstances when the same endoscope cannot be used to examine the nasal cavity and sinuses as well as the nasopharynx, oropharynx and larynx,” explains Cobuzzi.

Remember: Documentation for modifier XU claims “must stand up to clinical scrutiny, and this situation should rarely be encountered,” Cobuzzi says.