Wiki Modifiers X-EPSU

[liswoo]

I code Same Day Surgeries in a small hospital. I just learned today that our billing office is getting denials from medicare claims that have any of the X- mods appened to CPT codes. Is anyone else having this problem?

 

[rejenia]

Medicare has been actually paying our claims with the X modifiers. Make sure your using the correct one but they are also still excepting the 59 modifier also until they have training on the X modifiers.

 

[emcee101]

Same day (as E/M) surgeries are billed with either 25 or 57 depeding on the global period for the surgery. I'm a little confused how this is related to using the X(EPSU) modifiers, but maybe it was given just for context.

Anyways, I work for a comm. insurance company so I can't really speak for Medicare paying the X(EPSU) modifiers, or my companies payments either since it's not my department. That said, I see no reason why they would not if they were used correctly. Can you give an example of one of your rejections?

 

[teresabug]

emcee101 no, modifier 25 or 57 is only appended to an E/M code. We are speaking of 59 mod on a procedure code.

 

[teresabug]

there is no such thing as a same day E/M surgery. Per CMS, these new mods were to be accepted starting 1/1/15. I would appeal. Sounds like government enforcing things but yet they themselves are not ready.

 

[j.monday7814]

I code Same Day Surgeries in a small hospital. I just learned today that our billing office is getting denials from medicare claims that have any of the X- mods appened to CPT codes. Is anyone else having this problem?

we've been using the new modifiers for all payers since the beginning of the year. Medicare has paid the claims appropriately while our commercial payers and Medicaid has held off until mid-February before they started accepting them. Our MAC is Noridian if that helps. the easiest solution may be to rebill all the denials with modifier 59 and send test claims with an X- every week or so to see when they start accepting them.