Wiki 59 vs xe

[LRicci]

Hi,

We were told by an auditor for a large insurance company that we need to replace the 59 with XE. We code Dermatology and Mohs surgery in a private practice. We have documentation to support the 59 modifier. Does anyone have an opinion on this? None of our claims are being denied. We don't want to change this and we feel the auditor is incorrect.

Thank you,
Lisa Chavez, CPC

 

[thomas7331]

Medicare introduced the more specific modifiers XE, XS, XP and XU in 2015. These should be used in place of 59 if they apply, but 59 can still be used if there is no better modifier available. XE would only be appropriate if the patient returned for the distinct procedure at a separate encounter. For skin lesions on separate sites, as might apply in your situation, our practice has replaced 59 with XS for 'separate structure' to indicate that the procedure was done in a different location on the body. However, there is some debate about this because I've heard that certain payers interpret separate structure to mean a different body system, and in that case I think 59 would still be appropriate. Here is a link to the only guidance that I'm aware of from CMS on this at this time:

https://www.cms.gov/Outreach-and-Ed...k-MLN/MLNMattersArticles/downloads/MM8863.pdf

Hope this helps some.

 

[LRicci]

59 vs XE 2016

Thank you! We will continue to use modifier 59. Your explanation makes alot of sense.