Wiki Modifier 59 changes for GI services

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sbarrila

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Good Morning,
I have looked extensively on the CMS site, etc to find out any additional information on the use of the 59 modfier and the new X modifiers as it relates to GI services. We bill for Colonoscopies and EGDS in an Ambulatory Surgery Center and use the 59 modifier for multiple procedures when appropriate. I cannot determine from my readings is we will be able to continue to use this modifier or if we have to switch to the X modifiers. If we do need the X modifiers I cannot seem to determine which one is appropriate. Any help or direction to a website would be most appreciated. Thanks, Sue
 
Clear as Mud. Here is an Example of modifier XU I found online.

A diagnostic procedure is performed. Based on the findings, a therapeutic and/or surgical procedure is required on the same day.For example, diagnostic cardiac catheterization is followed by a medically necessary cardiac procedure.

XU Same encounter.
Same practitioner.
Same anatomical site, structure, or organ.

Looks like this would apply for a Screening Colonoscopy that based on the findings of a surgical procedure (polypectomy) is required.

I would like to see more examples of how the new modifiers should be used.......
 
I just did a webinar with FCSO and it was clear they didn't have any extra information that they hadn't already sent to us. It was very frustrating.

Examples given -
Patient present to orthopedic doctor for fracture care (cpt 25520). Provider tries to reduce fracture in office (unsuccessfully). Repeated procedure later that day at hospital by same provider.
Use XE - A service that is distinct because it occurred during a separate encounter.

Patient receives diagnostic angiography (cpt 93458). Results in percutaneous coronary intervention, same day.
Use XU - Unusual non-overlapping service, the use of a service that is distinct because it does not overlap usual components of the main service.

Patient presents for a destruction of an AK (17000). Biopsy of the skin also performed at a different anatomic site on the same side of the body. Same encounter.
Use XS - A service that is distinct because it was performed on a separate organ/structure.

Laparoscopic hernia repair performed in the morning by general surgeon A. Later that day, a laparoscopic appendectory is performed by general surgeon B of a different group.
Use XP - A service that is distinct because it was performed by a different practitioner.

After reading this a bit more, I feel like XU would be used if the AK and Biopsy were performed on the same anatomic structure, but on different lesions. Same encounter, same doctor, same structure but different lesions and therefore the services do not overlap.

I don't know if those examples help in this case. Check with your Medicare contractor and see if they have any classes for the X modifiers coming up.
 
Examples are confusing

The first example, about the orthopaedic and the fracture. Modifier 59 would not even be an option in that scenario anyway. I would use 78.
Another example, the last one I beleive about a " different practitioner". Again, if they were from the SAME practice, I would use mod 58. And if not from the same practice, modifier 59 would not even be an option. These "X" codes are only to be used to take the place of 59. This should not have to be so complicated.....
 
X modifiers & GI procedures

Please Clarify or Correct me if this is wrong.

XS ? ?Separate Structure, A service that is distinct because it was performed on a separate organ/structure?

Colon/LG Intestine is the organ; Appendix, Cecum, Ascending, Hepatic Flexure, Transverse, Splenic Flexure, descending & Rectum are part of it's structure. I am interpreting that different lesions/polyp within the same organ would be considered a separate structure.

I believe most of the Colonoscopy procedures would fall under the XS modifier, but not all:

Example of Modifier XS
Separate Structure:
Patient is having a Screening Colonoscopy

Dr. removed two polyps from the descending colon by snare and one polyp from the cecum by hot biopsy
and another polyp found in the rectum was removed with cold biopsy.
CPT 45380 XS-PT
CPT 45384 XS-PT
CPT 45385 PT

Example of Modifier XU:
Unusual Non-overlapping Service
Patient is having a Screening Colonoscopy

Dr. removes two polyps from the Hepatic flexure, one was easily removed by hot bx forceps and sent
to pathology the second polyp was flat and difficult to lift so the area was cauterized and the polyp
was not retrieved.
CPT 45384 PT
CPT 45388 UX-PT
 
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