Q&A: Reporting the -X{EPSU} modifiers

Q: Our facility has attempted to use the -X{EPSU} modifiers on 2017 and 2018 claims but our Fiscal Intermediary Standard System (FISS) did not process the claims. I reverted to using modifier -59 (distinct procedural service). Do you have any knowledge of when these modifiers might go into use?

A: They’ve been in use for quite a long time. I have audited claims that processed just fine. You need to double-check that this is something coming from the FISS and not your clearinghouse. You may want to reference a January 3 MLN Matters Special Edition Article with information on this topic, then call the FISS and ask why you are unable to use these on your claim.

Modifier -59 is fine to use, but sometimes you want to be more specific in your reporting. You can also go to your CMS regional office and, if there is an associate administrator at the regional office, you can report your problem to him or her.

At one point, Medicare said, and they continue to say, that they are going to issue specific guidance on which modifier should be used to resolve code pairs. I have not seen any issues with modifiers -XP (separate practitioner) and -XS (separate structure), but I have seen some issues with modifier –XU (unusual non-overlapping service). I think it’s because MACs are not 100% sure when that’s the correct modifier to use.

Editor’s note: Denise Williams, RN, COC, senior vice president of revenue integrity services at Revant Solutions, and Valerie A. Rinkle, MPA, lead regulatory specialist and instructor for HCPro's Revenue Integrity and Chargemaster Boot Camp, answered this question during the HCPro webinar, “Confronting NCCI/MUE Processes: Reduce Edits and Eliminate Obstacles.”

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