All posts by Kendra Blackmon

CMS Logo

In-Person ICD-10 Implementation Training from CMS

CMS wants to help clinicians and practice managers, especially those in smaller offices and rural office, to plan and prepare for ICD-10 implementation in 2015. For that reason, CMS will be sponsoring free, in-person training focused on how smaller practices should prepare for ICD-10. Note that these are in-person classes. We have training scheduled as shown.  If you are a coder, biller, office manager, or practice manager, please register for a “Billing Office” class. If you are a physician, NP, PA, CSW, RD, or other clinical professional, please sign up for a “Clinicians” class. In many cities, the classes are combined and the audience is shown as “Everyone.” CMS wishes to thank the many individuals who have worked to host and co-sponsor this training. We could not provide this timely service without your help.

CMS is working on additional classes for Anniston, AL (October 13), Tuskegee, AL (October 15), and Columbus, GA (October 15). If you know of a venue in Anniston, Tuskegee, or Columbus, please contact Keith Gilliam, 404-562-3007 or keith.gilliam@cms.hhs.gov.

If CMS is not providing in-person classes near you, check www.roadto10.org for webinars and other helpful information.

CMS Logo

CMS Adds Four Subset Modifiers for Modifier -59

According to CMS, they are establishing four new modifiers to define the subsets of the -59 modifier. -59 modifier is the most widely used Healthcare Common Procedure Coding System (HCPCS) modifier and can be broadly applied. CMS reports some providers incorrectly consider it to be the “modifier to use to bypass (NCCI)” and associated with considerable abuse.  Modifier -59 has high levels of manual audit activity which leads to reviews, appeals and even civil fraud and abuse cases.  Additional information regarding CMS’ view of how providers use modifier -59 is below.

FOUR NEW MODIFIERS – SUBSETS OF MODIFIER -59
CMS has defined the following four new HCPCS modifiers (referred to collectively as -X{EPSU} modifiers) to define specific subsets of the -59 modifier:

XE Separate Encounter
A Service That Is Distinct Because It Occurred During A Separate Encounter

XS Separate Structure
A Service That Is Distinct Because It Was Performed On A  Separate Organ/Structure

XP Separate Practitioner
A Service That Is Distinct Because It Was Performed By A Different Practitioner

XU Unusual Non-Overlapping Service
The Use Of A Service That Is Distinct Because It Does Not Overlap Usual Components Of The Main Service

CMS will not stop recognizing the -59 modifier but notes that CPT instructions state that the -59 modifier should not be used when a more descriptive modifier is available. CMS will continue to recognize the -59 modifier in many instances but may selectively require a more specific – X{EPSU} modifier for billing certain codes at high risk for incorrect billing.

Visit CMS Modifiers for a copy of the August 15, 2014 Change Request 8863, Transmittal 1422 from CMS with more details.  The effective date is January 1, 2015 with an implementation date of January 5, 2015.