ffective, January 5, 2015, the Centers for Medicare & Medicaid Services (CMS) implemented four new Healthcare Common Procedure Coding System (HCPCS) modifiers, which are intended to define subsets of modifier 59, Distinct Procedural Service.
The primary purpose of modifier 59 for the National Correct Coding Initiative (NCCI) is to indicate that two or more procedures were performed at different anatomic sites or different patient encounters. However, because modifier 59 applies to a wide variety of circumstances many times this modifier is inappropriately utilized to bypass NCCI edits.
The new modifiers are defined as follows:
XE — Separate Encounter, A Service That Is Distinct Because It Occurred 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
XU — Unusual Non-Overlapping Service, The Use Of A Service That Is Distinct Because It Does Not Overlap Usual Components Of The Main Service
Specific instructions regarding appropriate application of these new modifiers will be provided by CMS prior to implementation. At this time CMS will accept the reporting of either modifier 59 or the more selective modifier XE, XP, XS or XU. Additional information regarding the new modifier 59 subsets can be found at http://www.cms.gov.