What is xu modifier mean?
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Modifier 59 and other NCCI-associated modifiers should NOT be used to bypass an NCCI edit unless the proper criteria for use of the modifier are met. Documentation in the medical record must satisfy the criteria required by any NCCI-associated modifier used. From an NCCI perspective, the definition of different anatomic sites includes different organs or different lesions in the same organ. However, it does not include the treatment of contiguous structures of the same organ.
For example, treatment of the nail, nail bed, and adjacent soft tissue constitutes the treatment of a single anatomic site. Treatment of posterior segment structures in the ipsilateral eye constitutes the treatment of a single anatomic site. Arthroscopic treatment of a shoulder injury in adjoining areas of the ipsilateral shoulder constitutes the treatment of a single anatomic site.
One of the common misuses of modifier 59 is related to the portion of the definition of modifier 59 allowing its use to describe “different procedure or surgery”. The code descriptors of the two codes of a code pair edit consisting of two surgical procedures or two diagnostic procedures usually represent different procedures or surgeries. The edit indicates that the two procedures/surgeries cannot be reported together if performed at the same anatomic site and the same patient encounter.
NOTE: Two physicians in the same group, with the same specialty, performing services for the same patient on the same day, are considered to be the same physician by Medicare.
Reference: DEPARTMENT OF HEALTH AND HUMAN SERVICES
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● XU – “Unusual Non-Overlapping Service, the use of a service that is distinct because it does not overlap. usual components of the main service” Appropriate & Inappropriate Use of These Modifiers.
