Urology Modifiers Changes in 2017

For coders involved in urology coding, it’s imperative to know specific modifier changes in 2017. The risk of not being up-to-date would be denials, slashed reimbursement, and fraud charges while filing claims. As of late, the office of the Inspector General (OIG), in its analysis of the use of modifiers have discovered errors in the use of some of the most commonly used modifiers that have caused overpayments to urologists and other providers. This blog, will talk about one such modifier (modifier -59) as it is probably the most misunderstood modifier.

One of the misuses of modifier ‘–59’ is related to the portion of the definition of modifier ‘–59’ allowing its use to describe ‘different procedure or surgery,’ ” according to MLN article SE0715 and the NCCI Policy Manual. “The code descriptors of the two codes of a code pair edit usually represent different procedures or surgeries. The related NCCI edit indicates that the two procedures/surgeries cannot be reported together if performed at the same anatomic site and same patient encounter.”

The four new modifiers are as follows:

  • E: 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.

With these four new modifiers/subsets of Modifier 59, how do we best use them in 2017 and beyond, and does this help us understand what is billable together under certain circumstances and what is not? On one hand, these four new modifiers/subsets of Modifier 59 help us to better define how to properly use Modifier 59; on the other hand, they may also create confusion. The exact use of these modifiers remains undefined, as ultimately the use of any modifier remains the decision of the individual contractor’s interpretation. Not all contractors have yet stated if or when these new modifiers will be used; in addition, Modifier 59 was not eliminated and may still be used. Furthermore, several contractors had previously instructed their members to use or consider using Modifier 76 in many or all situations in lieu of Modifier 59 due to the aforementioned difficulties with Modifier 59.

For a complete update on CPT® and ICD-10 Coding in Urology 2017 and the correct use of modifiers in urology, attend this session with expert speaker Dr. Michael A. Ferragamo Jr. on Dec 1, 2016 during the Coding Updates Virtual Bootcamp 2016. Get the necessary information to avoid misuse of specific modifiers and to understand the overall use of modifiers in general. Additional explanations on how to avoid denials and to ensure proper payments will also be provided in this 75-minute session.

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