Author Topic: modifier XS ????  (Read 4014 times)

jennifer8055

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modifier XS ????
« on: September 19, 2014, 08:29:19 AM »
 :o

Today Medicare denied a claim that we bill on a daily basis.  One of the charges had a modifier -59 on it, like we normally put on the combination that we bill.....that charge was denied stating that the -59 was no longer sufficient, that we needed and "X" modifier (this is what our local MAC told us).  We were given the information, but the "memo" on it states it's not effective until January 2015.  How can they deny a claim for something that hasn't taken effect yet?

These are the modifiers listed on the CMS memo ---- "XE" - separate encounter - a service that is distinct because it happened during a separate encounter; "XS" - separate structure - a service that is distinct because it was performed on a separate organ/structure; "XP" - separate practitioner - a service that is distinct because it was performed by a different practitioner; and "XU" - unusual non-overlapping service - the use of a service that is distinct because it does not overlap usual components of the main service.

Has anyone else Medicare give them this information.......before 3 days ago, we had heard nothing of it.

CONFUSED.......
Jenn

Merry

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Re: modifier XS ????
« Reply #1 on: September 19, 2014, 09:31:52 AM »
You are correct. It doesn't go into effect til Jan. Sounds like your MAC jumped the gun. You need to contact them.

jennifer8055

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Re: modifier XS ????
« Reply #2 on: September 19, 2014, 09:45:26 AM »
that's kind of what i was thinking.....slowdown there cahaba.....

do you know if these are going to completely replace the 59 modifier or are these in addition to the 59 modifiers.  also, the XP modifier seems like it may replace either the 77(?) modifier or even the 80 modifier.  one of our providers is at a seminar this weekend and is meeting with medicare reps to get more information on this and we're trying to find if any of the seminars coming up on icd-10 will cover this issue.

thanks for your help!
jenn

RichardP

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Re: modifier XS ????
« Reply #3 on: September 19, 2014, 11:02:38 AM »
CMS will not stop recognizing the 59 modifier but notes that CPT instructions state that the 59 modifier should not be used when a more descriptive modifier is available.  CMS will continue to recognize the 59 modifier in many instances but may selectively require a more specific X {EPSU} modifier for billing certain codes at high risk for incorrect billing.


https://legacy.scanhealthplan.com/documents/hcc/tools/HCC%20U%20Posting%20for%20new%20HCPCS%20codes%20.pdf

jennifer8055

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Re: modifier XS ????
« Reply #4 on: September 19, 2014, 01:51:47 PM »
......but not until January 2015.  our mac seems to be trying to do things a little too early.

PMRNC

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Re: modifier XS ????
« Reply #5 on: September 22, 2014, 11:55:40 AM »
Many implementation dates with CMS have 90 day pre-implementation period.. you want to check that.
Linda Walker
Practice Managers Resource & Networking Community
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Merry

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Re: modifier XS ????
« Reply #6 on: October 09, 2014, 12:43:21 PM »
Not for these modifiers. Jan 2015 is the date. Especially confusing for dermatology and podiatric coders. Stay tuned as we learn how to decipher the information.

jennifer8055

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Re: modifier XS ????
« Reply #7 on: October 10, 2014, 11:30:39 AM »
very confusing...... ???

jennifer8055

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Re: modifier XS ????
« Reply #8 on: December 19, 2014, 08:25:01 AM »
has anyone heard anything new on this???  i have contacted our local mac on this and they keep referring me to the "med learn matters" memo that went out in september.  are these modifiers replacing the -59 or to be billed in addition to the -59??  we can't get anytype of specifics from our mac..... :-\

PMRNC

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Re: modifier XS ????
« Reply #9 on: December 19, 2014, 12:09:55 PM »
This is the CMS transmittal to MAC's. http://www.cms.gov/Regulations-and-Guidance/Guidance/Transmittals/Downloads/R1422OTN.pdf

At bottom it says this:
However, these modifiers are valid modifiers even before national edits are in place, so contractors are not prohibited from requiring the use of selective
modifiers in lieu of the general.

If you read the transmittal it states these are newer modifiers meant to provide more descriptive components of the -59. Yes you would use one of the X modifiers when needed. MAC's won't stop recognizing -59 but it should only be used as modifier of last resort. There's also an article on Physicians Practice at: http://www.physicianspractice.com/blog/medicare-moves-replace-modifier-59   that gives a few examples.

 
Linda Walker
Practice Managers Resource & Networking Community
One Stop Resources, Education and Networking for Medical Billers
www.billerswebsite.com

PMRNC

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Re: modifier XS ????
« Reply #10 on: January 25, 2015, 02:49:43 PM »
Friday, Medicare announced it would continue to take modifier -59 and that they will transition to the newer modifiers at later date:

Medicare announces to continue modifier -59 beyond 1/1/2015
http://www.cms.gov/Outreach-and-Education/Medicare-Learning-Network-MLN/MLNMattersArticles/downloads/SE1503.pdf
Linda Walker
Practice Managers Resource & Networking Community
One Stop Resources, Education and Networking for Medical Billers
www.billerswebsite.com