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New X modifer w/ Endoscopy

Sophie Posted Thu 12th of February, 2015 12:52:08 PM

If patient has colonoscopy with polyp removal in one area & biopsy in another area, which X modifier would be appropriate or would you stick to the -59??

45385
45380 -59 or –X_ modifier??

Thanks,
Melanie

SuperCoder Answered Thu 12th of February, 2015 19:41:33 PM

Thanks for your question. Medicare will still accept modifier 59 for distinct procedural service but it should not be used when a more specific modifier can apply. For this particular coding scenario, you should use the XS modifier. The XS modifier represents a separate structure. This modifier is used for a service that is distinct because it does not overlap usual components of the main service. See the attached article on the new EPSU modifiers for additional information.

https://www.supercoder.com/coding-newsletters/my-gastroenterology-coding-alert/modifiers-cms-unveils-4-new-modifiers-to-offset-unwarranted-use-of-59-144088-article

Sophie Posted Fri 27th of February, 2015 11:18:20 AM

I'm a bit confused, as it looks like many are since CMS didn't give very specific guidelines on the New X modifiers...when I looking back on previous questions that are just like my original question above, the response from SuperCoder was suggested to use -XS not -XU. Could you please have someone review these again and maybe put something in the Newsletter as to which of the two is best to use for GI offices when encountering the above scenario. Thanks for all your help.

Sophie Posted Fri 27th of February, 2015 11:24:56 AM

**forgot to add the user id's on the above confusion so you could find it better for review #27684 & #23222 both were asked 1month ago. thanks

SuperCoder Answered Sun 01st of March, 2015 23:26:40 PM

You are correct. The XS modifier would be appropriate for this scenario.

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