Wiki Bundled Services?

[AprilSueMadison]

I just finished a webinar with our Medicare contractor FCSO. I'm a bit irritated as it was over the new modifiers XE, XS, XP, and XU but it seemed as though they hadn't been trained on these either!

During the audio conference they (FCSO) keep saying (and by the way, everyone keeps disagreeing) that 17000 and 11100 on the same anatomic site are bundled services. They do not need a 59.

I'm frustrated...if my doctor does a biopsy on the right forearm because the patient has what appears to be a dysplastic nevus and then four inches away from that identifies an AK (702.0) and treats that...a CCI edit applies and I should be able to add a 59 and bill it and get paid for both, correct?

On that note....come January 1st, am I still using a 59 in that scenario? XS is the only other possible option out of the new modifiers....but that is for a separate anatomic location. I'm assuming 59 would still be more specific.

If we do what we were just told on this webinar, my biopsy won't pay and I'll have to appeal. If it DOES pay then a year from now we'll receive a refund request and have to appeal.

 

[CatchTheWind]

I think they told you wrong regarding the destruction and the biopsy. They would only be bundled if you performed both procedures on the SAME LESION. Otherwise, I would continue using modifier 59 on the biopsy.

My best guess is to use the XS modifier in this situation (for CMS and those commercial payers that want the EPSU modifiers), with the assumption that "separate organ/structure" also refers to separate lesions or separate sites. It seems that they just weren't being very precise about the language when they wrote these modifier descriptions!

 

[marieb]

New modifiers to replace 59

I'm confused as well. Can someone give an example of when to use the XU modifier in regards to dermatology?

 

[CatchTheWind]

Here's an example I've though of, although we have not yet tried it, so I don't know if it will result in payment:

Sometimes our providers will do a biopsy and a destruction on the same lesion at the same visit. The biopsy is bundled into the destruction code, so until now the provider has never been able to get paid for it (and we have never tried to use the 59 modifier, since it is on the same lesion). But the description of the XU modifier makes me think that perhaps we can bill separately for the biopsy if we use this modifier.