Are You Prepared to Use -X {EPSU} and -59 Modifiers?

Are You Prepared to Use -X {EPSU} and -59 Modifiers? Payment Strategies Kathleen D. Schaum, MS Wound care professionals often perform 2 procedures at the define a distinct service is common and not infrequently same patient encounter, but that does not mean that Medicare overrides the edit in the exact circumstance for which the CMS and/or other payers will always pay for both procedures. In created the edit in the first place. Because the -59 modifier can fact, the Medicare National Correct Coding Initiative (NCCI) be so broadly applied, some providers incorrectly consider it to includes Procedure-to-Procedure (PTP) edits that define when be the modifier to use to bypass NCCI optional edits. For these 2 Healthcare Common Procedure Coding System codes or reasons, the -59 modifier is associated with high levels of Current Procedural Terminology (CPT*) codes should not be manual audit activity that leads to reviews, appeals, and even reported together, either in all situations or in most situations. fraud and abuse cases. The NCCI PTP edits prevent unbundling and consequent Let’s review the -59 modifier guidance that the American overpayment to physicians and outpatient facilities for codes Medical Association and the CMS provided at the beginning that report overlapping services except in those instances of 2018: where http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png Advances in Skin & Wound Care Wolters Kluwer Health

Are You Prepared to Use -X {EPSU} and -59 Modifiers?

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Publisher
Lippincott Williams & Wilkins
Copyright
Copyright © 2018 Wolters Kluwer Health, Inc. All rights reserved.
ISSN
1527-7941
eISSN
1538-8654
D.O.I.
10.1097/01.ASW.0000530368.32544.16
Publisher site
See Article on Publisher Site

Abstract

Payment Strategies Kathleen D. Schaum, MS Wound care professionals often perform 2 procedures at the define a distinct service is common and not infrequently same patient encounter, but that does not mean that Medicare overrides the edit in the exact circumstance for which the CMS and/or other payers will always pay for both procedures. In created the edit in the first place. Because the -59 modifier can fact, the Medicare National Correct Coding Initiative (NCCI) be so broadly applied, some providers incorrectly consider it to includes Procedure-to-Procedure (PTP) edits that define when be the modifier to use to bypass NCCI optional edits. For these 2 Healthcare Common Procedure Coding System codes or reasons, the -59 modifier is associated with high levels of Current Procedural Terminology (CPT*) codes should not be manual audit activity that leads to reviews, appeals, and even reported together, either in all situations or in most situations. fraud and abuse cases. The NCCI PTP edits prevent unbundling and consequent Let’s review the -59 modifier guidance that the American overpayment to physicians and outpatient facilities for codes Medical Association and the CMS provided at the beginning that report overlapping services except in those instances of 2018: where

Journal

Advances in Skin & Wound CareWolters Kluwer Health

Published: Jan 1, 2018

References

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