The CPT Manual defines modifier 59 as Distinct Procedural Service: Under certain circumstances, it may be necessary to indicate that a procedure or service was distinct or independent from other non-E\/M (Evaluation\/Management) services performed on the same day. Modifier 59<\/a> is used to identify procedures\/services, other than E\/M services, that are not normally reported together, but are appropriate under the circumstances. Documentation must support a different session, different procedure or surgery, different site or organ system, separate incision\/excision, separate lesion, or separate injury (or area of injury in extensive injuries) not ordinarily encountered or performed on the same day by the same individual. However, when another already established modifier is appropriate, it should be used rather than modifier 59. Only if no more descriptive modifier is available, and the use of modifier 59 best explains the circumstances, should modifier 59 be used.<\/p>\n Separate Encounter, a service that is distinct because it occurred during a separate encounter. Only use XE to describe separate encounters on the same date of service.<\/p>\n Separate Structure, a service that is distinct because it was performed on a separate organ\/ structure.<\/p>\n Separate Practitioner, a service that is distinct because it was performed by a different practitioner.<\/p>\n Unusual Non-Overlapping Service, the use of a service that is distinct because it does not overlap usual components of the main service.<\/p>\n Using modifiers 59 or \u2013XS properly for different anatomic sites during the same encounter only when procedures which aren\u2019t ordinarily performed or encountered on the same day are performed on different organs, or different anatomic regions, or in limited situations on different, non-contiguous lesions in different anatomic regions of the same organ. Modifiers 59 or \u2013XS are for surgical procedures, non-surgical therapeutic procedures, or diagnostic procedures. From an NCCI program perspective, the definition of different anatomic sites includes different organs or, in certain instances, different lesions in the same organ.<\/p>\n Only use modifiers 59 or -XE if no other modifier more properly describes the relationship of the 2 procedure codes. Another common use of modifiers 59 or \u2013XE is for surgical procedures, non-surgical therapeutic procedures, or diagnostic procedures that are performed during different patient encounters on the same day that can\u2019t be described by one of the more specific NCCI PTP-associated modifiers.<\/p>\n Don\u2019t use modifiers 59 or \u2013XU just because the code descriptors of the 2 codes are different. One of the common misuses of modifier 59 relates to the part of the definition of modifier 59 allowing its use to describe a \u201cdifferent procedure or surgery.\u201d The code descriptors of the 2 codes of a code pair edit describe different procedures, even though they may overlap. Don\u2019t report the 2 codes together if they\u2019re performed at the same anatomic site and same patient encounter, because they aren\u2019t considered \u201cseparate and distinct.\u201d Don\u2019t use modifiers 59 or \u2013XU to bypass a PTP edit based on the 2 codes being \u201cdifferent procedures.\u201d However, if you perform 2 procedures at separate anatomic sites or at separate patient encounters on the same date of service, you may use modifiers 59 or \u2013X{ES} to show that they\u2019re different procedures on that date of service. Also, there may be limited circumstances sometimes identified in the National Correct Coding Initiative Policy Manual for Medicare services when you may report the 2 codes of an edit pair together with modifiers 59 or \u2013X{ES} when performed at the same patient encounter or at the same anatomic site.<\/p>\n There are 3 other limited situations where you may report 2 services as separate and distinct because they\u2019re separated in time and describe non-overlapping services even though they may occur during the same encounter.<\/p>\n We shared appropriate & inappropriate use of modifiers 59 & XE\/XP\/XS\/XU for your reference only, for detailed understanding of these modifiers with examples, you can refer MLN document<\/a>.\u00a0 Medisys Data Solutions is a leading medical billing company<\/a> providing complete assistance in medical billing and coding. To know more about our billing and coding services, contact us at info@medisysdata.com\/ 302-261-9187.<\/p>\n","protected":false},"excerpt":{"rendered":" Definition of Modifier 59 The CPT Manual defines modifier 59 as Distinct Procedural Service: Under certain circumstances, it may be necessary to indicate that a procedure or service was distinct or independent from other non-E\/M (Evaluation\/Management) services performed on the same day. Modifier 59 is used to identify procedures\/services, other than E\/M services, that are […]<\/p>\n","protected":false},"author":1,"featured_media":7863,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"_coblocks_attr":"","_coblocks_dimensions":"","_coblocks_responsive_height":"","_coblocks_accordion_ie_support":"","footnotes":""},"categories":[3],"tags":[247],"class_list":["post-7862","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-medical-billing-services","tag-medicalbilling-medicalcoding-healthcare-physician-medicare"],"yoast_head":"\nDefinition of Modifier XE\/XP\/XS\/XU<\/h2>\n
Modifier XE<\/h3>\n
Modifier XS<\/h3>\n
Modifier XP<\/h3>\n
Modifier XU<\/h3>\n
Appropriate & Inappropriate Use of Modifiers<\/h2>\n
\n