Philadelphia Regional Ophthalmic Society
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Sean Patrick Murphy

 

 

PROS Message Center: 215-825-4725 Email: pros@eyetechs.org

Modifier 59 and New Modifiers XE, XS, XP, XU

Modifier 59 is used  to identify  Distinct Procedural Service other than E/M services, which 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)

Note: When another already established modifier is appropriate, report it instead of modifier 59. Use modifier 59 only if no other descriptive modifier is available.

Do not report modifier 59 or other modifiers to bypass an  NCCI edit  bundling a procedure unless documentation in the medical record supports its use.

The Centers for Medicare & Medicaid Services (CMS) established four (4) new HCPCS modifiers (XE, XS, XP, andXU) to provide greater reporting specificity in situations where modifier 59 was previously reported.

Modifiers (collectively referred to as -X {EPSU} modifiers) are defined as follows:

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”

Although NCCI will eventually require use of these modifiers rather than modifier 59 with certain edits, you may begin using them for claims with dates of service on or after January 1, 2015.

Note: You have the option to continue using modifier 59 in any instance in which it was correctly used prior to January 1, 2015. CMS' additional guidance and education as to the appropriate use of the new -X {EPSU} modifiers will be released soon.

As a reminder, your medical documentation must support the use of modifiers.  Inappropriate unbundling procedures using modifier 59 can be subject to audit and is included in the OIG list.


Special Benefit for Members Only

PROS members can participate in a 529 College Saving Plan through Hilliard Lyons. The plan allows members to put money in tax-free account for educational expenses. For more information, contact Jay Weinberg at:
1-800-222-2024
or by email at:
Jweinberg@hilliard.com


Instructional Materials Library

Videotapes of PROS meetings and other topics, including the skills evaluation video, are available from our library.
To borrow a tape, contact Kathy Santa Maria at: 302-798-5777, Ext. 216

The American Society of Ophthalmic Administrators (ASOA)
has donated the following books to the PROS library:

Step by Step Guidebook to Completing an Ophthalmology Practice Budget, prepared by the BSM Consulting Group

The Women of Ophthalmology, John B. Pinto & Elizabeth A. Davis, M.D.

John Pinto’s Little Green Book of Ophthalmology

Cash Flow, John B. Pinto & E. Ann Rose

The Efficient Ophthalmologist, John B. Pinto

Ophthalmology Regulatory Manual, Fifth Edition

PROS members may borrow books free of charge. Contact Kathy Santa Maria for information. 302-798-5777 x 16 or email ksm1735@verizon.net

For more information about ASOA, go to www.ASOA.org


Membership Information

Membership dues cover attendance to all meetings.  All technical meetings and workshops are approved for JCAHPO continuing education credits on a 1:1 basis.

Members also receive our newsletter. Non-members are held on the PROS mailing list for only three years.

Membership dues are renewed every January 1st. Memberships are available for both administrative and technical personnel. Annual dues are $40.00. Please make check payable to PROS and mail to:

Executive Director
Maria C. Massini, COT
2427 South 20th Street
Philadelphia, PA 19145

Print out the membership form here!

Please indicate your certification level and if you want to be included in the administrative or technical mailing list or both.

PROS Message Center: 215-825-4725 Email: pros@eyetechs.org