AMA Clinical Examples in Radiology - 2014 Bulletin 2
Four New HCPCS Modifiers to Define Distinct Procedural Services
Four New HCPCS Modifiers to Define Distinct Procedural Services The Centers for Medicare and Medicaid Services (CMS) will establish four new HCPCS modifiers as a subset of the 59 modifier to define a "Distinct Procedural Service" [see Change Request (CR) 8863] at http://www.cms.gov/Regulations-and-Guidance/Guidance/Transmittals/Downloads/R1422OTN.pdf . CMS noted that the use of modifier 59 is associated with considerable abuse and high levels of manual audit activity, leading to reviews, appeals, and even civil fraud and abuse cases. The four new specific modifiers, effective January 1, 2015, with an implementation date of January 5, 2015, are: XE Separate Encounter: A...
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Article Overview
This article covers CMS guidance on newly established HCPCS modifiers for distinct procedural services, including the reason for the change, the effective and implementation dates, and the relationship to existing billing and compliance practices. It is relevant to coders, billers, compliance staff, and radiology coding professionals who need to understand current CMS modifier guidance and related Medicare Learning Network references.
Why This Topic Matters
The topic matters because modifier selection affects claim accuracy, audit exposure, and payer compliance, especially when CMS specifies more granular reporting for certain services.
What You Will Learn
- Why CMS introduced additional HCPCS modifiers for distinct procedural services
- How the new modifiers fit alongside existing modifier guidance
- What timing and implementation details accompany the CMS update
- Where the article directs readers for related Medicare guidance
Who Should Read This
- Medical coders
- Billing professionals
- Compliance staff
- Radiology coding specialists
- Medicare claims staff
Modifiers Discussed
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