Are you tired of getting the denials on your medical claims with modifier 59 that identifies that a procedure is distinct and separately payable from another procedure performed on the same day on the same patient? If yes, then it is time you conduct an internal audit, review all the denied claims with modifier 59, and ask yourself, ‘Am I overusing the 59 modifier?’.
The Centers for Medicare and Medicaid Services (CMS) introduced a new set of modifiers to prevent the misuse and overuse of modifier 59. This guide is dedicated to one of those modifiers, the XS modifier! So, without further ado, let’s get started!
XS Modifier – Description
XS modifier is one of the X{EPSU} modifiers that CMS introduced back in 2015 as a subset of modifier 59 to offer more specificity while coding distinct procedures performed on the same day. This modifier indicates to the insurance payer that a specific service is distinct and separately payable because it was performed on a different structure or organ of the same patient on the same day. This modifier is vital to avoid bundling issues and duplicate billing errors.
Comparing the XS Modifier with Other X{EPSU} Modifiers
The XS modifier indicates that a procedure is distinct from another procedure performed on the same day for the same patient during the same encounter. While the other modifiers indicate the following details:
- XE modifier denotes that the services were rendered during separate encounters on the same day.
- XP modifier means that separate providers performed distinct care procedures.
- XU modifier highlights that the procedures typically do not overlap, but in a specific scenario, they did.
Scenarios Where an XS Modifier is Applicable
Let’s consider some scenarios where this modifier can be applied to gauge its scope of usage:
Orthopedic Procedures
Assume a patient who visits an orthopedic surgeon with a torn rotator cuff and a fractured ankle. Thus, the surgeon performed a rotator cuff repair (upper extremity) and an open reduction and internal fixation of the ankle fracture (lower extremity) on the same day.
Here, both procedures were rendered on the same day but are separate and distinct because they involved different structures/organs, i.e., lower and upper extremities. Therefore, the XS modifier could be appended to the internal fixation of the ankle fracture procedure to ensure rightful reimbursements.
Interventional Radiology
What happens when a patient undergoes an angiogram of the renal arteries (renal system) followed by an angiogram of the coronary arteries (cardiac system) on the same day? Should you append modifier 59 to identify to the payer that both the modifiers are distinct and separately identifiable? No! Because there is another modifier available that best describes the scenario since both the angiograms were performed on different anatomical sites.
Thus, to avoid duplicate billing issues, you should append the XS modifier to the angiogram performed on the coronary arteries to highlight to the insurance payer that both procedures are separately billable since they were performed on different patient organs.
Gynecologic Procedures
Consider a scenario where a patient undergoes a hysterectomy (removal of the uterus) and an appendectomy (removal of the appendix) during the same surgical session.
Since both procedures were performed on different organs, i.e., the reproductive and digestive systems, the XS modifier can be applied to the appendectomy code.
Modifier XS – Billing Guidelines
Discussed below are the XS modifier billing requirements:
Use When Same Patient, Same Day, But Different Organ/Structure
If two services are rendered to the same patient on the same day, but the procedures were performed on different structures or organs, you should append the XS modifier.
Not using this modifier would typically result in bundling of the multiple procedures performed on the same day for the same patient as per the National Correct Coding Initiative (NCCI) edits.
Do Not Confuse Organs/Structures with Anatomic Sites
You should not confuse separate structures with different human body parts. Separate structures refer to distinct organ systems or anatomic sites.
For instance, if a procedure was performed on the right hand, followed by another procedure on the left hand, you cannot append the XS modifier. The reason? Since both procedures were rendered on the musculoskeletal system of the upper extremities, i.e., the same anatomic site.
Provide Detailed Documentation
Comprehensive documentation is another requirement for reporting the XS modifier with a procedure code. Thus, ensure your documentation clearly states the specific structure or organ on which each care procedure was rendered, establishes the medical necessity for each service, includes relevant anatomical identifiers (if any), and mentions the sequence and time of each rendered procedure.
Common Mistakes Related to the Use of the XS Modifier
Some common mistakes that healthcare providers make while appending this modifier are listed below:
- Using it when the services were rendered on the same structure or organ system.
- Failure to submit adequate and accurate documentation justifying the use of this modifier.
- Appending it to procedures that are not distinct and separately billable as per the NCCI edits.
- Inappropriately adding it to claims to get higher reimbursements by bypassing the NCCI service bundling edits.
Best Practices to Avoid Inappropriate Use of the XS Modifier
Here are some industry best practices to help you avoid overusing and misusing this modifier:
- Carefully review the clinical notes and details about the rendered care services to ensure you are using the most appropriate X{EPSU} modifier.
- Review the documentation and double-check for inaccuracies that may lead to claim denials or audits.
- Before appending this modifier, check with the payer to ensure the rendered procedures are distinct and separately payable.
- Conduct regular internal audits to ensure that your practice is not overusing or misusing this modifier to avoid audits and reputational damage.
- Invest in ongoing training of your billing staff to ensure they are well-versed in the medical coding and billing best practices and the appropriate use of modifiers.
Summary
Let’s quickly recap what we discussed in this guide! We explained that the X{EPUS} modifiers were induced by CMS in 2015 to offer added coding specificity while billing distinct and separately payable procedures, and the XS modifier is part of it. We also shared some examples where two procedures were rendered for the same patient on the same day during the same encounter but on different organs or structures.
Furthermore, we discussed the billing requirements, common reporting mistakes, and best practices associated with the XS modifier. We hope these details will help you ensure the appropriate use of this modifier. However, if you still find it challenging, feel free to partner with our medical billing specialists at MediBillMD to supercharge your collections.
