2015 NCCI Coding Policy Changes: Modifier -59

CMS has taken the position that the CPT modifier “-59” is widely overutilized.  As a result, they have created four new modifiers to be used instead of the -59, in most cases.  According to the National Correct Coding Initiative (NCCI), modifier -59 should only be used when there is no other modifier that describes the relationship of the codes.

These new modifiers were developed to provide greater reporting specificity in situations where modifier 59 was previously reported.  These codes should be used instead of modifier 59 whenever possible.

The four new modifiers can be used beginning with dates of service January 1, 2015.

Break Away from the Static

Below is a description of the new modifiers:

  • 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.

As always, ADVOCATE will keep you updated on this and other issues impacting radiology as they become available.

Best regards,
Kirk Reinitz, CPA
President/CEO