New CPT Code Modifiers from Medicare – 2015

The “59 modifier” is under the gun. CMS is implementing four new HCPCS modifiers effective January 1, 2015. Instructions state that modifier 59 should not be used when a more specific modifier is available and the new modifiers to be used for their purpose are XE, XS, XP, and XU.

The modifiers:

XE, Separate Encounter: A service that is distinct because it occurred during a separate encounter.

Example: If a patient came in for an outpatient EKG, then comes back later in the day for blood work, the blood work would require an XE modifier.

XS, Separate Structure: A service that is distinct because it was performed on a separate organ/structure.

Example: If a wound is repaired on a patient’s arm, but there is also a wound on the leg, the coding would represent the arm wound and the legal wound, with the modifier XS after the leg wound code.

XP, Separate Practitioner: A service that is distinct because it was performed by a different practitioner.

Example: It’s a little unclear, but probable use is in a scenario like this: The patient is seen by one provider who in the course of treating a patient encounters a problem outside his scope of ability so calls in another doctor to perform the service.

XU, Unusual non-overlapping service: The use of a service that is distinct because it does not overlap usual components of the main service.

Example: Excision of two non-contiguous lesions on the same structure or body area that might typically be bundled together can be separated by this modifier.

CMS will likely release further clarification of scenarios for these modifiers before the end of the year. We’ll post more information as it is made available.