Cardiology Coding Alert

Question: Is it true that Medicare is no longer accepting modifier 59?

Maryland Subscriber

Answer: The short answer is no. Medicare is still accepting modifier 59 (Distinct procedural service).

What you heard may relate to two different changes. First, and already in place, many MACs accept modifier 59 only for properly overriding a Correct Coding Initiative edit. They no longer accept modifier 59 for other purposes such as a repeat procedure on the same date.

Second is a change that’s in the works. Medicare has announced that effective Jan. 1, 2015, and implemented Jan. 5, 2015, there will be four new modifiers that are more specific than modifier 59:

• XE, Separate encounter, a service that is distinct because it occurred during a separate encounter
• XS, Separate structure, a service that is distinctbecause it was performed on a separate organ/structure
• XP, Separate practitioner, a service that is distinct because it was performed by a different practitioner
• XU, Unusual non-overlapping service, the use of a service that is distinct because it does not overlap usual components of the main service.

Medicare will still accept modifier 59, but in 2015, you should use one of the above modifiers when it is more appropriate than 59 for the given case.

You can review the MLN Matters article at www.cms.gov/Outreach-and-Education/Medicare-Learning-Network-MLN/MLNMattersArticles/Downloads/MM8863.pdf.