Pathology/Lab Coding Alert

Question: What are some pathology or laboratory examples of when we might use one of the X{ESPU} modifiers instead of modifier 59?

Missouri Subscriber

Answer: The Centers for Medicare & Medicaid Services (CMS) advises that, when medically appropriate, you use the most specific modifier to override a National Correct Coding Initiative (NCCI) edit pair for services for the same patient on the same service date. Ideally, you would use one of the following modifiers when you have documentation that supports circumstances more specific than those described by modifier 59 (Distinct procedural service):

• 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)

For example: The lab evaluates a bronchoalveolar lavage (BAL) specimen using liquid cytology, and also examines a direct sputum specimen from the same patient on the same date. Report the service as 88112 (Cytopathology, selective cellular enhancement technique with interpretation (eg, liquid based slide preparation method), except cervical or vaginal) for the BAL, and 88161-XS (Cytopathology, smears, any other source; preparation, screening and interpretation) (Separate structure) for the sputum exam.

Example 2: The surgeon submits a fine needle aspiration (FNA) lesion specimen to the pathologist for examination. The surgeon also calls the pathologist into surgery during a percutaneous needle biopsy of the same lesion and the pathologist performs a touch prep examination of the tissue. NCCI bundles 88333 (Pathology consultation during surgery; cytologic examination (eg, touch prep, squash prep), initial site) as a column 2 code for 88172 (Cytopathology, evaluation of fine needle aspirate; immediate cytohistologic study to determine adequacy for diagnosis, first evaluation episode, each site). However, these represent distinct specimens from different procedures, so you may override the edit pair with modifier XU.

Example 3: The pathologist consults on an outside breast case, prepares standard slides from the submitted tissue block(s), and reports 88323 (Consultation and report on referred material requiring preparation of slides). The pathologist orders immunohistochemistry-stained slides from their affiliated histology lab, which bills to 88342 (Immunohistochemistry or immunocytochemistry, per specimen; initial single antibody stain procedure) for the service. NCCI bundles 88342 as a column 2 code with 88323. Because the stain is a separate encounter from the 88323 consultation, you may override the edit pair with modifier XE.