Radiology Coding Alert

Plus: Rely on modifier XS over 76 in when the situation calls for it.

In Radiology Coding Alert Volume 20, Issue 2, you went over real-world examples of when, where, and how to apply the XE (Separate encounter) and XU (Unusual non-overlapping service) modifiers to your radiology practice claims. This month, you will encounter two final examples to close out the set of X{EPSU} modifiers.

Applying, when necessary, modifiers XP (Separate practitioner) and XE (Separate encounter) to eligible Medicare Part B claims isn't difficult as long as you have a firm grasp on how each modifier is distinct from one another.

Check out these two examples to round out your knowledge of the entire X{EPSU} modifier set.

Know When Identical Codes Don't Coincide with Identical Procedures

Example 1: A patient presents for two separate tendon sheath injections for the left knee and left elbow performed by the same physician.

Typically, one would make the assumption that you should apply a modifier 76 (Repeat procedure or service by same physician or other qualified health care professional) to any two identical codes. However, while these two codes may be the same, the procedures they represent are not. Since the injections are focused on separate anatomical sites, you should instead opt for the XS modifier to document separate structures. The coding is as follows:

• 20550-LT – Injection(s); single tendon sheath, or ligament, aponeurosis (eg, plantar "fascia")
• 20550-LT, XS 

Caution: There have been known instances in which Medicare or a Medicare Advantage Plan has denied a duplicate procedure with modifier XS applied instead of modifiers 76 or 77 (Repeat procedure by another physician or other qualified health care professional). In these cases, resubmit the claim with one of these two traditional duplicate modifiers instead.

Don't Consider X{EPSU} for Code Sets Without CCI Edits

Example 2: A patient presents to the emergency room (ER) for a computerized tomography (CT) scan of the head without contrast and a magnetic resonance imaging (MRI) of the head without contrast. Two separate providers interpret the services.

Here's your trick question of the day. Since there are not any Correct Coding Initiative (CCI) edits between these two codes, you should not consider the use of modifier XP in this situation. Simply make sure that each separate provider is documented for the scan respectively interpreted and send the claim on its way using the following codes:

• 70450 - Computed tomography, head or brain; without contrast material
• 70551 - Magnetic resonance (eg, proton) imaging, brain (including brain stem); without contrast material.

However, if, for example, you replace the CT scan with a magnetic resonance angiography (MRA) scan, such as 70546 (Magnetic resonance angiography, head; without contrast material(s), followed by contrast material(s) and further sequences), you would apply the XP modifier to 70551 (the column 2 code).

"Remember that, while there are instances when an XP is the sole modifier, in most cases an additional modifier is necessary to unbundle the services for Medicare patients," says Amanda Corney, MBA, medical billing operations manager for Medical Resources Management in Rochester, New York. That's because, if the claims are bundled under CCI edit rules, they are most likely requiring modifiers XE, XS, or XU in addition to XP (consider the first scenario with differing physicians performing each injection).