XS vs 59 modifier

[p100]

Lately I have heard podiatrists talk about the XS modifier. One person said they get reimbursed 100% for all procedures performed on the same patient. For example nails and calluses both get reimbursed at full price and not 50% for the second procedure.

My online research has not made the difference between 59 and XS clear to me nor if I should use XS at all. My practice manager has not heard of XS. Do any of you use XS modifier?

---

Members don't see this ad.

 

[619]

I have not heard about XS modifier. I use 59 which pays half for the secondary procedure. Will like to hear more about XS if anyone uses it.

 

[Adam Smasher]

I use XS for medicare and medicaid only. It's a more specific version of 59. It doesn't get me 100% for my line 2 CPT code. The advantage of the XS modifier is it slips you under the radar if your 59 modifiers ever get audited.

 

[ExperiencedDPM]

The 59 modifier is often abused. It’s not to eliminate an edit, it’s do note that the procedure is for a different pathology at a different location.

And it’s to report procedures that are not normally reported together.

Example 1. You perform a hammertoe repair, 28285 on the second toe and a flexor tenotomy on the 3rd toe.

There is an edit for 28285 with 28232. But in this case the 59 is to note that the 28232 is on a DIFFERENT toe.

Using 59 for the 28232 for the same toe as the 28285 would be a MISUSE of the modifier.

 

[Pronation]

The 59 modifier is often abused. It’s not to eliminate an edit, it’s do note that the procedure is for a different pathology at a different location.

And it’s to report procedures that are not normally reported together.

Example 1. You perform a hammertoe repair, 28285 on the second toe and a flexor tenotomy on the 3rd toe.

There is an edit for 28285 with 28232. But in this case the 59 is to note that the 28232 is on a DIFFERENT toe.

Using 59 for the 28232 for the same toe as the 28285 would be a MISUSE of the modifier.

Ok so what I’m gathering from this is that when I need to bill 7 different CPT codes on the single toe that I’m doing surgery on then I need to be sure to use the XS modifier so I don’t get in trouble.

 

[AttackNME]

The 59 modifier is often abused. It’s not to eliminate an edit, it’s do note that the procedure is for a different pathology at a different location.

And it’s to report procedures that are not normally reported together.

Example 1. You perform a hammertoe repair, 28285 on the second toe and a flexor tenotomy on the 3rd toe.

There is an edit for 28285 with 28232. But in this case the 59 is to note that the 28232 is on a DIFFERENT toe.

Using 59 for the 28232 for the same toe as the 28285 would be a MISUSE of the modifier.

I have used the T modifiers for that to specify the toe, arent we supposed to use the most specific modifier to distinguish distinct and separate?

 

[apollofx]

59 is general, XS is more specific.