Patient relationship codes: CMS drops a hint about the other X modifiers

by: Julia Kyles, CPC May 13, 2019

Had you forgotten about the new patient relationship category modifiers unveiled in the 2018 Medicare physician fee schedule? CMS hasn't. The five new modifiers are still out there and still voluntary. But expect Medicare to shift to mandatory reporting of the modifiers soon as part of the cost portion of the merit-based incentive payment system (MIPS).

CMS instructed Medicare administrative contractors to accept and process claims with modifiers X1-X5 in a change request published May 10. CMS 100-20, Change Request 11259 emphasized that use of the codes designed to show the provider’s relationship with the patient at each encounter has been voluntary since the codes were introduced in 2018. CMS also touted the benefits of practicing with the codes and hinted that the voluntary practice period won’t last forever.

Reporting of these modifiers will be mandatory in the near future and CMS advises clinicians to participate for easier transition.

The change request did not provide a more detailed timeline but it is clear the mandatory use of the codes is still in the works. Doctors and non-physician practitioners at your practice may not be thrilled by the prospect of more modifiers, but the change request and a pending MedLearn Matters article provide opportunities to educate them about the new codes.

Even if they just don’t want to hear about it right now, you can start thinking about how services they regularly perform might match up with the different modifiers.

X1 (Continuous/broad services). Services by clinicians who provide the principal care for a patient, with no planned endpoint of the relationship.
X2 (Continuous/focused services). Services by clinicians whose expertise is needed for the ongoing management of a chronic disease or a condition that needs to be managed and followed for a long time.
X3 (Episodic/broad services). Services by clinicians who have broad responsibility for the comprehensive needs of the patients, that is limited to a defined period and circumstance, such as a hospitalization.
X4 (Episodic/focused services). Services by specialty-focused clinicians who provide time-limited care. The patient has a problem, acute or chronic, that will be treated with surgery, radiation, or some other type of generally time-limited intervention.
X5 (Only as ordered by another clinician). Services by a clinician who furnishes care to the patient only as ordered by another clinician. This patient relationship category is reported for patient relationships that may not be adequately captured in the four categories described above.

You can find more information about the codes and how they should be used in the handout, transcript and FAQs for a webinar CMS conducted Feb. 21, 2018. A recording of the webinar – complete with closed captioning option – is available on YouTube.

Blog Tags: CMS, Quality payment program

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