Pain Management Coding Alert

Published on Mon Jun 05, 2017 PDF

Here’s why you shouldn’t be using these modifiers regularly.

While CPT^® still has modifier 59 (Distinct procedural service) in the manual, more payers are requiring you to use the more specific X{EPSU} modifiers in place of 59.

Check it out: The most commonly used X{EPSU} modifiers are XS (Separate structure) and XE (Separate encounter). There are two other X modifiers, however: XP (Separate practitioner) and XU (Unusual non-overlapping service). And if you haven’t used these modifiers much, you’re not alone.

Encounters that you’ll code with modifiers XP and XU “will be very infrequently seen,” relays Barbara J. Cobuzzi, MBA, CPC, CENTC, COC, CPC-P, CPC-I, CPCO, AAPC Fellow, Vice President at Stark Coding & Consulting, LLC, in Shrewsbury, N.J. “If you find yourself using the XP and XU modifiers often, you maywant to reconsider the usage as this will set off a red flag.”

If you do come across an XP or XU scenario, however, you need to recognize it. Check out some choice advice from Cobuzzi, which helps illustrate when you might need to use XP or XU.

2 Physicians Usually Means XP Encounter

A modifier XP scenario “usually involves one surgeon who does one stage of the surgery and another who performs a second stage, where the two stages would be considered bundled,” explains Cobuzzi.

“This may be encountered during a cancer or trauma when two physicians from the same practice are providing service to a patient which may be considered bundled services, but because the two services were provided by two different physicians because they have different subspecialties, the services are each separately payable via the XP modifier,” Cobuzzi continues.

Meet XU, the ‘Infrequent Modifier’

The XU modifier should be the least-used modifier option, Cobuzzi says. Modifier XU situations “represent the real exception that is most rarely encountered, and if this modifier is used more than one or two times a year, it is probably being used too much.”

Remember: Documentation for modifier XU claims “must stand up to clinical scrutiny, and this situation should rarely be encountered,” Cobuzzi says.