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CPT MANUAL PROFESSIONAL EDITION 2018 MANUAL
CPT MANUAL PROFESSIONAL EDITION 2018 CODE
CPT MANUAL PROFESSIONAL EDITION 2018 PROFESSIONAL

with CPT 19083: Biopsy, breast, with placement of breast localization device(s) (eg, clip, metallic pellet), when performed, and imaging of the biopsy specimen, when performed, percutaneous, first lesion, including ultrasound guidance and.

CPT 76642: Ultrasound, breast, unilateral, real time with image documentation, including axilla when performed (limited).

CMS regulations indicate modifier XE gives a more specific description of modifier 59.īased upon the above indicators, it appears it is appropriate to bill the following: Modifier 59 indicates a separate procedure. A modifier is necessary to indicate the procedures were performed on the same date but separately. (Breast ultrasound was performed but not at the same time as the breast biopsy, which used ultrasound guidance.) Two separate procedures were performed at different sessions on the same date. The description of the procedures performed. One of those new modifiers XE is defined as "a service that is distinct because it occurred during a separate encounter."

Effective January 1, 2015, CMS regulations brought forth four new modifiers to give more specification to modifier 59 (distinct procedural service).

Historically, modifier 59 is used to indicate a distinct procedural service.

Modifier "XE" was used to indicate separate (distinct) procedure for CPT 19083 because the procedures were performed at different times (sessions).

The provider billed CPT 76642 and CPT 19083, which was modified with "XE.".

A diagnostic breast ultrasound (CPT 76642) and an ultrasound guided biopsy (CPT 19083) were performed on the same date of service but at different sessions for a patient.

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." … These modifiers, collectively referred to as -X modifiers, define specific subsets of the -59 modifier.

CPT MANUAL PROFESSIONAL EDITION 2018 MANUAL

Pursuant to CMS Manual System, Pub 100-20 One-Time Notification, Transmittal 1422, Effective Janu(available at Transmittals/Downloads/R1422OTN.pdf), "CMS has defined four new HCPCS modifiers to selectively identify subsets of Distinct Procedural Services (-59 modifier) as follows: XE Separate Encounter, A Service That Is Distinct Because It Occurred During A Separate Encounter. Documentation must support a different session, different procedure or surgery, different site or organ system, separate incision/excision, separate lesion, or separate injury (or area of injury in extensive injuries) not ordinarily encountered or performed on the same day by the same individual. Modifier 59 is used to identify procedures/services, other than E/M services, that are not normally reported together but are appropriate under the circumstances.

Modifier 59: Distinct Procedural Service: Under certain circumstances, it may be necessary to indicate that a procedure or service was distinct or independent from other non-evaluation and management (E/M) services performed on the same day.

Modifier XE: Separate Encounter * (HCPCS modifier for selective identification of subsets of Distinct Procedural Services ).

CPT MANUAL PROFESSIONAL EDITION 2018 PROFESSIONAL

Modifier Definitions (CPT 2018 Professional Edition) CPT 19083: Biopsy, breast, with placement of breast localization device(s) (eg, clip, metallic pellet), when performed, and imaging of the biopsy specimen, when performed, percutaneous, first lesion, including ultrasound guidance.Listed under Diagnostic Ultrasound Category. Report 76641, 76642 only once per breast, per session. CPT 76642: Ultrasound, breast, unilateral, real time with image documentation, including axilla when performed limited.

CPT MANUAL PROFESSIONAL EDITION 2018 CODE

Noted facts from the scenario include Breast ultrasound (CPT 76642), Ultrasound guided biopsy (CPT 19083-XE), procedures performed on same date, and procedures done at different time on same date.ĬPT Code Definitions (CPT 2018 Professional Edition) Can we bill with the XE in this scenario? Historically, if a breast ultrasound (CPT 76642) was done on the same date but at a different time and then the patient returned later in the day for an ultrasound guided biopsy (CPT 19083 -XE), we would code with a modifier XE. I have a question regarding radiography and biomedical imaging that was initiated by a coding scenario.

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