Examples When to Use Modifier XS

March 30, 2015
Rick Gawenda

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 not infrequently overrides the edit in the exact circumstance for which the Centers for Medicare and Medicaid Services (CMS) created the edit in the first place. The CMS has implemented 4 new subsets of modifier 59 to combat the abuse of Modifier 59 and to better understand why providers utilize modifier 59. In this post, I will provide 2 examples of when the XE modifier would be appropriate to use. The definition of Modifier XS is

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  1. in example one, the patient is seen in the same clinic by the same therapist for 2 separate conditions. I thought this was a no no in regard to MC billing. Or is this what the modifiers are going to begin to allow?

    1. The Medicare program has never limited how many conditions we can treat on one Medicare beneficiary.

  2. Rick…our billing/coding folks in our outpatient hospital setting are questioning reimbursement for bilateral unna boots. Would adding modifier 50 still be the appropriate way to bill this on a medicare claim? thanks
    Mary Lamb

    1. Modifier 50 could be one option as thatb indicates bilateral procedure. If that does not work, may need to use modifier RT on 29580 on one line item for right and modifier LT on 29580 on a second line item to indicate left.

  3. I am very confused. At one time, it was my understanding through Rick that the “XE, XS, XP, XU” modifiers were not going to be applicable to Outpatient Rehab. Recently, all the Gawenda updates I have received in March make me feel that three of the four are applicable and that we should start transitioning to them as a mandatory date is on the horizon and these are applicable to Outpatient Rehab???

    1. Gawenda Seminars & Consulting has always said the new modifiers would be applicable to outpatient therapy services. CMS has not implemented them as of today’s posting to outpatient therapy services.