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X modifier for multiple units of surgical pathology code

TnRushFan

Networker
Messages
46
Best answers
0
Good afternoon everyone,

When I was hired at my current job at a hospital many, many years ago I was instructed not to append -59 to multiple counts of the pathology codes [eg. 88300-26 x2]. We have never had any issues...now our billing department is wanting the "X" modifiers appended to them.

My question:
Is it appropriate to code 88300-26-XU for the gross description of two separate specimen? Or any other surgical pathology code with multiple counts of the same code, gross was just an example?

Thanks
 

bbooks

Expert
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373
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0
I presume you mean you've been instructed to code this way for Medicare. Where I work, I am coding for MAC in two different states. It is frustrating that MACs differ on their preference for coding multiple specimens, especially if the #units exceed MUE, and when we have multiple specimens and multiple reports from the same DOS. We have been using 59 modifier instead of X-modifiers as well, but we've been having more trouble this past year with denials and having to appeal. We are currently trying to decide if X-modifier would be preferable.

The X-modifier choices are:
XE – “Separate encounter, A service that is distinct because it occurred during a separate encounter” This modifier should only be used to describe separate encounters on the same date of service.
XS – “Separate Structure, A service that is distinct because 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”

To understand your question completely, could you provide a sample report? Also, in the case of using 88300, were there any other pathology charges on that same DOS?

Thanks...we are trying to figure this out, too. :)
 
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