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modifier XS ????

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jennifer8055:
 :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:
You are correct. It doesn't go into effect til Jan. Sounds like your MAC jumped the gun. You need to contact them.

jennifer8055:
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:
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:
......but not until January 2015.  our mac seems to be trying to do things a little too early.

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