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Modifier -59 (distinct procedural service) should be used to indicate instances that a procedure or service was distinct or independent from other non-E/M services performed on the same day. Modifier -59 should not be appended to an E/M service. Circumstances that may warrant the use of modifier -59 include:
Modifier -59 also assists in the reporting of codes designated as "separate procedures." The separate procedure designation indicates that a certain procedure or service may be performed independently or is unrelated or distinct from other procedure(s)/service(s) provided at that time. When a procedure or service that is designated as a separate procedure is carried out independently or considered unrelated or distinct from other procedures or services provided at that time, then it is appropriate to report the procedure separately with modifier -59 appended. When a "separate procedure" is carried out as an integral component of another procedure or service performed at the same time, the procedure should not be reported in addition to the procedure of which it is considered an integral component.
CMS has defined the following four (4) new HCPCS modifiers to selectively identify subsets of Distinct Procedural Services (-59 modifier) effective 1/1/2015:
-XE (Separate Encounter)-A Service That Is Distinct Because It Occurred During A Separate Encounter
-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 (Unsual Non-Overlapping Service)-The Use Of A Service That Is Distinct Because It Does Not Overlap Usual Components Of the Main Service
Modifier 59 is not being deleted. BCBSMS will continue to recognize the -59 modifier. At times, medical records may be requested for claims appended with modifier -59 and/or any of the new modifiers.
Below are just a few examples of when it is appropriate to use modifiers -59, -XE, -XS, -XP, and/or -XU:
The coding guidelines outlined in Coding Policy should not be used in lieu of the Member's specific benefits plan language.
1/2003: Policy developed.
9/17/2007: Example of when to use modifier -59 (6th bullet) revised to clarify intent of statement.
6/25/2008: Policy revised to add statement "At times, medical records may be requested when modifier -59 is appended."
12/2/2014-Added information for 'X' modifiers. Revised guidelines for 29877 (shaving of articular cartilage) when filed with meniscal shavings (29880, 29881), due to coding guidelines and code description changes for 29880 and 29881. Revised coding guidelines for modifier-59 for clarity of the intent.