You’re going to get a break when you use a distinct procedure modifier such as
59 or
XS (Separate structure, a service that is distinct because it was performed on a separate organ/structure) to unbundle a coding edit for a Medicare claim. Effective July 1, you will be able to append these modifiers to the column one or the column two code,
CMS announced Feb. 15, in CMS 100-20, Change Request 11168.
MCS system maintainers shall update the claim adjudication rules for NCCI PTP edits to allow bypass of an edit with CCMI of “1” if modifiers 59, XE, XS, XP, or XU are appended to either the column one or column two code.
Here’s an example of how this policy could make your billing a little bit easier.
A doctor performs 20611 (Arthrocentesis, aspiration and/or injection, major joint or bursa [eg, shoulder, hip, knee, subacromial bursa]; with ultrasound guidance, with permanent recording and reporting) on a patient’s left knee and 64450 (Injection, anesthetic agent; other peripheral nerve or branch) on the patient’s right arm. The peripheral block is bundled into the joint injection, but in this instance the practice could use a modifier to break the edit pair and report both services.
- Before July 1 – The practice must append the modifier to 64450, the column two code.
- After July 1 – The practice may append the modifier to 20611 or 64450.