Modifier XP Examples

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…

2016 Medicare Payment Update

On October 30, 2015, the Centers for Medicare and Medicaid Services (CMS) issued “Proposed policy, payment, and quality provisions changes to the Medicare Physician Fee Schedule for Calendar Year 2016” final rule updating payment policies, payment rates, and quality provisions for services furnished under the Medicare Physician Fee Schedule (PFS) on or after January 1,…

Modifier XE Examples

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…

New Subsets of Modifier 59

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 by one discipline to the same Medicare beneficiary during the same treatment session or same date of service when multiple disciplines treat the Medicare patient within the same organization (non-private…

ICD-10 Transition Going Smoothly

On October 1, 2015 health systems across the country transitioned to the International Classification of Diseases, 10th Revision – ICD-10. This change will enable providers to capture more details about the health status of their patients to improve patient care and public health surveillance. The Centers for Medicare and Medicaid Services (CMS) has been carefully…