AHA Coding Clinic® for HCPCS - 2014 Issue 4

Subsets of Modifier 59

ffective, January 5, 2015, the Centers for Medicare & Medicaid Services (CMS) implemented four new Healthcare Common Procedure Coding System (HCPCS) modifiers, which are intended to define subsets of modifier 59, Distinct Procedural Service. The primary purpose of modifier 59 for the National Correct Coding Initiative (NCCI) is to indicate that two or more procedures were performed at different anatomic sites or different patient encounters. However, because modifier 59 applies to a wide variety of circumstances many times this modifier is inappropriately utilized to bypass NCCI edits. The new modifiers are defined as follows: XE — Separate Encounter, A...

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