Modifier 59, Distinct Procedural Service — Under certain circumstances, it may be necessary to indicate that a procedure or service was distinct or independent from other non-E/M services performed on the same day. Modifier 59 is used to identify procedures/services, other than E/M services, that are not normally reported together, but are appropriate under the circumstances. Documentation must support a different session, different procedure or surgery, different site or organ system, separate incision/excision, separate lesion, or separate injury (or area of injury in extensive injuries) not ordinarily encountered or performed on the same day by the same individual. However, when another already established modifier is appropriate, it should be used rather than modifier 59. Only in situations where there is not a more descriptive modifier available, and the use of modifier 59 best explains the circumstances, should modifier 59 be used. Note: Modifier 59 should not be appended to an E/M service. To report a separate and distinct E/M service with a non-E/M service performed on the same date, see Modifier 25.
Because Modifier 59 applies to a wide variety of circumstances, many times this modifier is inappropriately appended to bypass NCCI edits. With the intent of defining the various subcategories of Modifier 59 subsets were established for use in January 5, 2015.
The subsets of Modifier 59 are 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
However, since the implementation of the subsets of Modifier 59 there have been no specific instructions regarding the appropriate application of these modifiers. The most current information available is that CMS will continue accepting the reporting of either modifier 59 or the more selective modifier XE, XP, XS or XU. For more information regarding the use of modifier 59, go to www.cms.gov.
Let us take a look at the question and answer below:
There is a polyp in the sigmoid and transverse colon; one removed via cold, the other snare. Would I append modifier 59 or XS in this case? I have been appending modifier 59 because XS states separate structure. The transverse and sigmoid are both part of the colon. Which is correct?
Since there is no guidance regarding the use of the modifier 59 subsets, and therefore, not clear whether the transverse and sigmoid colon would be considered separate structures for the purpose of using modifier XS, the use of modifier 59, Distinct Procedural Service, would be more appropriately appended in this case.