“X” Subset Modifiers and Orthopaedic Clinical Examples

Mary LeGrand, RN, MA, CCS-P, CPC

Confusion about modifier 59 and the “X” subset modifiers is evident in the responses from orthopaedic practices to a recent survey conducted by Karen Zupko & Associates, Inc. Modifier 59 is used to indicate that a procedure or service was distinct or independent from other non-evaluation and management services performed on the same day. The “X” subset modifiers were introduced in 2013 to define specific subsets of the -59 modifier. Practices are submitting claims to private payers and Medicare carriers without clarifying rules, guidance, and examples of how to use the new modifiers, and receiving mixed responses. Examples include, but are not limited to, the following:

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