2015 Coding Modifiers Providers Should Know


The 2013 Comprehensive Error Rate Testing Report claims that $2.4 billion in Medical Physician Fee Schedule payments were made with Modifier-59, with a $320 million error. This large error may be due to the fact that the 59- modifier is used in a broad spectrum of circumstances.

Providers use Modifier-59 to indicate that a code represents a service that is separate from another service that would normally be bundled together.

The Center for Medicare and Medicaid Services (CMS) alleges that some abuse Modifier-59 to bypass National Correct Coding Initiative. Furthermore, Modifier-59 has a large amount of manual audit activity, which means there is a high rate of civil fraud and abuse.

Beginning January 1st, the CMS will establish the following four new HCPCS modifiers: Modifier XE, Modifier XS, Modifier XP, and Modifier XU. The CMS predicts that the more specific modifiers will reduce the amount of errors.

The CMS will still recognize Modifier-59, but it should not be used when a more descriptive modifier is available. The CMS may require a more specific modifier when billing certain codes that are at high risk for incorrect billing.

Summary by MedicalGroups.com

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