Wiki Xs modifier

[MATHEODO]

XS Separate Structure, A Service That Is Distinct Because It Was Performed On A Separate Organ/Structure.

NCCI defines different anatomic sites to include different organs or different lesions in the same organ. Rhat being said, would a 59 mod or an XS mod. be more appropriate in the following scenario. I'm getting different opinions.

The member had two lesions removed on the same day. Both lesions were on the face. One on the forehead one on the cheek.

A 1.2 cm basal cell carcinoma (11642) of the cheek was excised and closed with a simple closure. CPT code 11642 describes excision of a malignant lesion of the face, but is not specific to the cheek.

A 1.8 cm basal cell carcinoma was excised from the forehead, but the closure was with a flap procedure (CPT 14040).

According to coding rules, the excision is included in the flap procedure. Since this rule is in place, and the code 11642 is not specific to the forehead or cheek, it would look like 11642 is being billed with 14040 for an excision of a single lesion of the face, not 2 separate and distinct lesions. Without a modifier, CPT 11642 would be denied as included in 14040.

Here is the confusion..would a XS modifier be appended to the 11642 or a 59. I am leaning to the XS.

thanks
Peggy

 

[em2177]

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

Modifier 59 is used to identify procedures/services that are commonly bundled together but are appropriate to report separately under some circumstances.

I would use the XS modifier.

 

[MATHEODO]

Modifier XS

Yes the two codes would normally be bundled. An excision and a flap, and if it were last year it would be a 59. This year, I agree with you XS is more appropriate. Thanks

Peggy

 

[morganingle]

you can still use modifier 59 if you are unsure..the new x modifiers are not required as of yet