Wiki Xs modifer

[kkasper290]

I am getting conflicting answers of when to us the Mod-XS

Medicare pt. comes in for 11100 and 17000 bx and destruction both done on the right arm. Is it correct to put the XS on the 17000 code. Or is it 59 because it is the same structure.

I am confusing myself with the explanation (separate organ/structure)

And if it is they are billing 11100 and 17000 for the bx on leg and destruction on face is that when we bill XS.

Thanks for any help or examples.

Kathy

 

[JesseL]

I would still use modifier 59 as this is a separate lesion on the same arm, I also assume when they say "separate organ/structure" it implies different body areas. Not sure if you should use modifier "XU" though... but it's not like they're not accepting modifier "59" so might be best to use that to be on the safe side?

 

[ollielooya]

Hey, Kathy, you are a "neighbor!" Just to make sure I ran these two codes thru my editing program and evdn though the biopsy allows a larger reimbursement the modifier would go on the 11100 and not on the 17000 code. There are some edits where the more expensive service are "endowed" with the 59 modifier rather than the lesser.

NSG published more information on your procedure and suggests using the modifier XS on the 11100 rather than modifier 59. Hope it ok to post their link here....it's a long one!

http://www.ngsmedicare.com/ngs/port...gsLOC=Connecticut&jurisdiction=Jurisdiction K

 

[Scatlot]

I'm confused regarding the XS modifier. The example given in the NGS Medicare article looks like the patient had a destruction of a liver lesion and then had a skin biopsy, in which case the XS modifier would be appropriate since it is two separate organs. However, if the lesions are from the skin, for example the arm and leg, the skin is one organ, thus only modifier 59 would apply. Plus the example for modifier 59 states it should be used for excision of different skin lesions since it is the same organ structure. If I'm reading this wrong, please let me know.

 

[CatchTheWind]

No one really knows, because CMS has not explained how the new modifiers are meant to be used. I do understand, though, that they will eventually replace modifier 59 entirely, which means that one of the X modifiers will have to be used when two procedures are performed on the same body part; the best guess for which of these is XS.

We are assuming that the verbiage of the XS description is not to be taken too literally, and that when they say "separate organ/structure" this also means separate lesion (even if on the same body area).

 

[AprilSueMadison]

No one really knows, because CMS has not explained how the new modifiers are meant to be used. I do understand, though, that they will eventually replace modifier 59 entirely, which means that one of the X modifiers will have to be used when two procedures are performed on the same body part; the best guess for which of these is XS.

We are assuming that the verbiage of the XS description is not to be taken too literally, and that when they say "separate organ/structure" this also means separate lesion (even if on the same body area).

We are finding our XS submissions are denying this way. I agree with you and think that is how it is meant, but we've stopped using the new X modifiers until we get more information.

FCSO is our contractor and we got denials that look the same as if we left a 59 off of something.