In January 2015, the Centers for Medicare and Medicaid (CMS) implemented the EPSU modifiers which defined subsets of modifier 59 and provided further specificity regarding why two codes with a National Correct Coding Initiative (NCCI) edit should be reported together. CMS will continue to recognize modifier 59, and Medicare Administrative Contractors (MACs) can determine whether they will require the new EPSU modifiers when documentation supports the use of one of the modifiers, or if they will continue to recognize modifier 59 only.
Providers and coders should check with their local MAC to determine if the EPSU modifiers will be recognized.
- XE Separate Encounter: This modifier represents a service that is separately reportable because it occurred during a separate encounter
Example: A sixty-five year old patient had a planned tracheostomy tube placement. Later that same day, the patient had a bronchoscopy for acute respiratory distress.
- XS Separate Structure: This modifier represents a service that is separately reportable because it was performed on a separate organ/structure (note: a separate structure can also be defined as a non-contiguous lesion in the same organ).
Example: A seventy year old patient presents for a diagnostic colonoscopy due to rectal bleeding. During the exam, a polyp is discovered in the cecum and removed with cold biopsy forceps. A second polyp is noted in the sigmoid colon and removed by snare polypectomy.
- XP Separate Practitioner: This modifier represents a service that is separately reportable because it is performed by a different practitioner.
Example: A sixty-eight year old patient presents to the emergency department with multiple lacerations from a motor vehicle accident. The emergency department physician performs an intermediate repair of a 2.5 cm laceration on the right arm and then calls a general surgeon for a consult for a more extensive laceration on the left leg. The surgeon performs an intermediate repair of a 7 cm laceration on the left leg.
- XU Unusual Non-Overlapping Service: This modifier represents a service that is separately reportable because it does not overlap usual components of the same service to which it would otherwise bundle.
Example: A seventy-five year old patient presents to the ER with sudden onset of angina. The patient is taken to the cath lab where a diagnostic heart cath of the coronary arteries is performed and reveals occlusion of the LAD. Based on the results of the diagnostic cath, a decision is made to percutaneously insert a stent in the LAD.