12 Changes That Will Affect Doctors' Income in 2015

Leigh Page


November 25, 2014

In This Article

12. Four New CPT Modifiers Aim for Greater Specificity

In January, CMS will declare war on one of the most widely used—and misused—modifiers for Current Procedural Terminology (CPT) codes, which operates as a catch-all for services that cannot be adequately defined. In place of the amorphous modifier 59 in the Healthcare Common Procedure Coding System (HCPCS), physicians' offices will be using four new subset modifiers.

"Modifier 59 gets overused," said Susan Roehl, a healthcare manager at Eide Bailly in Fargo, North Dakota. "That is why CMS has come up with four additional clarifying modifiers. The extra modifiers give payers a better idea of what the indication was."

The subset modifiers are XE, XS, XP and XU. Roehl gave examples for each use:

EX covers separate encounters: The patient received an outpatient infusion of antibiotics in the morning, left the facility, and returned in the evening for another infusion.

XS covers a separate structure: A skin lesion of the arm was removed with laser surgery, and then another lesion was biopsied on the leg.

XP covers a separate practitioner: A laparoscopic hernia repair was performed in the morning by one surgeon, and then later in the day another surgeon performed a laparoscopic appendectomy on the same patient.

XU covers an unusual nonoverlapping service: Two separate lesions are present that are within the same code set, and are excised separately.

"The hope is that the new modifiers will make it easier to make payments to physicians, but we'll have to see," Roehl said. "They provide more specificity on what the actual procedure entails."


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