Currently, providers can use the -59 modifier to indicate that a code represents a service that is separate and distinct from another service with which it would usually be considered to be bundled. The primary issue associated with the -59 modifier is that it is defined for use in a wide variety of circumstances, such as a use to identify different encounters, different anatomic sites, and distinct services. Usage to identify a separate encounter is infrequent and usually correct; usage to define a separate anatomic site is less common and problematic; usage to define a distinct service is common and

Currently, providers can use the -59 modifier to indicate that a code represents a service that is separate and distinct from another service with which it would usually be considered to be bundled. The primary issue associated with the -59 modifier is that it is defined for use in a wide variety of circumstances, such as a use to identify different encounters, different anatomic sites, and distinct services. Usage to identify a separate encounter is infrequent and usually correct; usage to define a separate anatomic site is less common and problematic; usage to define a distinct service is common and

Currently, providers can use the -59 modifier to indicate that a code represents a service that is separate and distinct from another service with which it would usually be considered to be bundled. The primary issue associated with the -59 modifier is that it is defined for use in a wide variety of circumstances, such as a use to identify different encounters, different anatomic sites, and distinct services. Usage to identify a separate encounter is infrequent and usually correct; usage to define a separate anatomic site is less common and problematic; usage to define a distinct service is common and

The Centers for Medicare and Medicaid Services has updated several fact sheets including Medicare Physician Fee Schedule, Medicare Fraud and Abuse, Medicare Enrollment Guidelines for Ordering/Referring Physicians, and Medicare Compliance Products. To access each Fact Sheet, Gold Members log into your account and if not a Gold Member, join now and then click on the appropriate link below

The Office of Inspector General has released a report recommending that the Centers for Medicare and Medicaid Services (CMS) seek legislation to adjust Critical Access Hospital (CAH) swing-bed reimbursement rates to the lower SNF PPS rates paid for similar services at alternative facilities. CMS agreed with our finding that CAHs’ swing-bed utilization has increased but disagreed with our recommendation because of concerns with our findings on the availability of skilled nursing services at nearby alternative facilities and our calculation of savings. To read the full report, click HERE.

Modifier 59 is used in the outpatient therapy setting to identify when one intervention was provided at a separate and distinct time from another intervention to the same Medicare beneficiary during the same treatment session. Modifier 59 is not only the most commonly used modifier, but is also the most abused modifier that is utilized. Due to this, the Centers for Medicare and Medicaid Services (CMS) has defined four new HCPCS modifiers to selectively identify subsets of Distinct Procedural Services (-59 modifier). The effective date of the new subsets of modifier 59 was January 1, 2015; however, CMS has not

The Centers for Medicare and Medicaid Services (CMS) has issued additional guidance regarding the new subsets of modifier 59 (i.e. XE, XP, XS, and XU) that became effective January 1, 2015 and the continued use of modifier 59 after January 1, 2015. In the updated guidance, CMS states providers may continue to use modifier 59 after January 1, 2015 in any instance in which it was correctly used prior to January 1, 2015. Additional guidance and education as to the appropriate use of the new modifiers will be forthcoming as CMS continues to introduce the modifiers in a gradual and

I often have therapists tell me they are treating a current patient for a specific diagnosis/condition and that the patient will be returning to see their physician for a follow-up visit. The therapist tells me they wrote a Progress Report and sent it to the physician to provide the physician with the most current status of their patient. In order to write the Progress Report, the therapist not only gathered subjective comments from the patient and/or their family, but also gathered objective data, tests, and measures that included range of motion measurements and manual muscle testing. Since the therapist took