Wiki Modifier 59 for duplicate service- no mue, no cci edit. I disagree.

[1formissy]

Would like everyone's opinion with this situation. I have a series of CPT codes reported on the same encounter, same patient, ect. There are duplicate service codes reported for one service. The MUE is 2, and there are no NCCI edits when coded with the other services on the same claim.
A colleague of mine is adamant that we should report that code, on two different lines, with a modifier XS on the second line.
My argument is, that CPT code, has a MUE of 2, is not subject to the multiple payment policy indicator of 2, nor the payment policy indicator of 3, and has no bundled edits, therefore, we should be reporting that code, one one line, with a total unit of 2 in lieu of reporting the XS modifier, and splitting out the code.

Any takers on this? I am fully aware of Medicare's guidelines with regards to the 59 modifier, but I do not see anything that can back up my analysis of this stating we should not be reporting this way, because it is improper coding, and can trigger an audit.

 

[ellzeycoding]

What are the codes? That may help.

 

[mitchellde]

it does depend on what you are coding, some procedure/services it is appropriate to use multiple units while others must be split into multiple line items with modifiers.

 

[1formissy]

It was billed as

99222-25
37244
36247
36248
36248-XS
75726-26,XU
75774-26,XU
76937-26
99152
99153

I agree with all of it, except 36248 which has a MUE of 2, and no NCCI Edits. So, I would have reported it on one line, with a total of 2 units, and NO modifier. This is the problem I am having where a overriding edit modifier would not apply.

 

[ellzeycoding]

You are correct, CPT 36248 should be billed in units, not on separate lines.

 

[mitchellde]

I am curious about the use of the XU modifier for the angiography. what is the reason for selecting that modifier for those codes. I am just curious.

 

[1formissy]

I am not sure why she choose the XU modifier. Far as reporting on one line for the other code, does anyone have something in writing from CMS indicating that is the correct way to report it?

Seems like a he said, she said, and another external coder stated the way it was coded, (XS) is correct. So, it's different people saying different things.

I am so confused !

 

[1formissy]

I am curious about the use of the XU modifier for the angiography. what is the reason for selecting that modifier for those codes. I am just curious.

Debra, are you pretty good at Angio coding? Is that XU modifier not correct? I am an E/M coder/auditor and GI coder. So, interventional is not my strong point!

 

[mitchellde]

the XU modifier is used to unbundle services because it is an unusual circumstance. What about this is unusual? You should never assign codes or modifiers without knowing why they have been selected for a particular encounter. This is not a normal way to code these so I asked. I cannot advise the proper coding without the actual note. You should go online for information on interventional coding there are many resources. I know that the CPT assstant has a few back issues on proper coding of these codes and AHIMA has put a few things out there as well.

 

[espressoguy]

I've never really thought about why we use an XU modifier (or previously a 59) on these. This may not be the best answer, but this is the way I was trained. I also have a couple of reference books that indicate this is correct.

Now that you brought this up and I have given it some thought here's my stab on it. These codes are normally bundled. However, a diagnostic angiogram is allowed with an intervention when there is no recent diagnostic angiogram available and the decision to intervene is based on the diagnostic study OR their are changes from the previous angiogram.

During a cardiovascular intervention there are multiple angiograms done to verify the intervention is successful. These are not billable.

Here are the resources that I use:

Navigator for Comprehensive Edition 2015 Edition, published by Coding Strategies
Diagnostic & Interventional Cardiovascular Coding Reference 2016 Edition, published by ZHealth Publishing

 

[1formissy]

Debra, this is something I had questioned too. It seems to me that the new modifiers, XU, XS, XP, and XE are carelessly being used like the 59 modifier.
I appreciate everyone's input on this and will utilize the information you all have provided to continue in my investigation.
Thank you all very much!