Changes to the Modifier 59

The Centers for Medicare Services (CMS) recently published changes to the Modifier 59 that will go into effect on January 1, 2015.

Background Information:

According to CMS, the modifier 59 is the most widely used modifier and has been associated with considerable abuse and coding errors by providers Because it has the ability to bypass the National Correct Coding Initiative (NCCI), CMS decided to implement new modifiers that could be better describe a situation that requires Distinct Procedural Service.

The new modifiers that will go into effect on January 1, 2015 are outlined below:

1.    XE (Separate encounter, a service that is distinct because it occurred during a separate encounter).
2.    XS (Separate structure, a service that is distinct because it was performed on a separate body part).
3.    XP (Separate practitioner, a service that is distinct because it was performed by a different practitioner).
4.    XU (Unusual non-overlapping service, the use of a service that is distinct because it does not overlap usual components of the main service).

CMS transmittal 1422 explains that there may be a need for modifier 59, however, but it should not be reported when a more specific modifier is available.

The transmittal link is included for you to review.

www.cms.gov/Regulations-and-Guidance/Guidance/Transmittals/Downloads/R1422OTN.pdf

TheraOffice response:

TheraOffice is currently ready to handle new modifiers without an update to the software.  TheraOffice can also be customized by the end users to create rules associated with the use of modifiers to ensure compliance.  Hands on Technology is currently investigating other features that can be added to TheraOffice to ease the impact of the changes to the modifier 59 which will go into effect on January 15, 2015.

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