Wiki PT and XS modifiers

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Mrsrsnapp

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If an insurance requires the PT modifier for a screening colonoscopy that turns therapeutic would it be appropriate to use the XS modifier if two polyp removal techniques are used or would you use the 59 modifier? I have been using the PT/XS combination on Medicare and some commercial and my coworker has been using the PT/59 combination on commercial. She is under the impression that the XS modifier is only for Medicare. Please advise. Thank you.
 
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This may continue the debate, I read this as (see link examples). Almost don't matter, 59 vs XS are one in the same. As long as your applying them correctly, my super prefers XS in the context you mention. I use 59, just to get my work done.

Trying to debate the point like 33 vs PT won't work, it's not the same with 59 vs XS.

To be on the same page, maybe run it by the supervisor. Should we do it this way for Medicare and this way for Commercial. If you not getting denials, then it doesn't really matter is my take.

 
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daniel said:
This may continue the debate, I read this as (see link examples). Almost don't matter, 59 vs XS are one in the same. As long as your applying them correctly, my super prefers XS in the context you mention. I use 59, just to get my work done.

Trying to debate the point like 33 vs PT won't work, it's not the same with 59 vs XS.

To be on the same page, maybe run it by the supervisor. Should we do it this way for Medicare and this way for Commercial. If you not getting denials, then it doesn't really matter is my take.

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Thank you. I didn't think it mattered either but it made me question what I'd been doing for 3 years.
 
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We have moved over to X modifiers vs using 59. We have noticed that our commercial payers and Medicare are more likely to pay when we use them. I think it's up to the discretion of the payer, but as most of us know, commercial payers follow suit to Medicare. If you have success with both, you could pick which one is your preferred method, but I do think one way should be used and stuck with. Before we decided to use the X modifiers, we tracked a few claims to see if they were paid, maybe try that?
 
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mikaylalynn9127 said:
We have moved over to X modifiers vs using 59. We have noticed that our commercial payers and Medicare are more likely to pay when we use them. I think it's up to the discretion of the payer, but as most of us know, commercial payers follow suit to Medicare. If you have success with both, you could pick which one is your preferred method, but I do think one way should be used and stuck with. Before we decided to use the X modifiers, we tracked a few claims to see if they were paid, maybe try that?
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So did you find that the payers who denied the second procedure code with a 59 modifier attached ended up paying for the second procedure if an X modifier was used? Example 45385 and 45380-59/XS and 43249 and 43239-59/XS
 
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Mrsrsnapp said:
So did you find that the payers who denied the second procedure code with a 59 modifier attached ended up paying for the second procedure if an X modifier was used? Example 45385 and 45380-59/XS and 43249 and 43239-59/XS
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We have noticed commercial payers will more likely pay with X modifiers. It was explained to us that X modifiers can be more specific than slapping a 59 on it to get it paid. Once we started correcting our claims from 59 to XS there were less denials. I really recommend trying it on a few claims and tracking them to see if this is the case for you too. I’m in Missouri.
 
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Mrsrsnapp said:
Thank you. I didn't think it mattered either but it made me question what I'd been doing for 3 years.
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It does matter which modifier you use 59 or an -X modifier. Your facility should have a list of insurance companies and which modifier they use. Example: Medicare and Medicare Products usually use the X modifiers. Commercial or third-party payers, have their own rules and don't always go by Medicare.

PT/33 modifiers are used with: Medicare & Medicare Products using -PT and for most commercial/third-party payers using -33 for screenings converted to diagnostic.
 
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