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The Ins and Outs of Separate and Distinct Services - Documentation and Coding

OnDemand Webinar (61 minutes)

Make sure your services have clinical documentation that supports the use of modifiers that will help your claims get paid.Many times health care providers and facilities receive claim rejections and denials because claims that have been submitted with modifiers for separate and distinct services (59, XE, XS, XP and XU) do not meet the requirements as outlined by National Correct Coding edits or in the payers' reimbursement policy guidelines. This topic helps individuals who are responsible for the billing and coding of facility and health care provider services ensure that there is clinical documentation that supports the use of these modifiers, and to ensure clinical services meet the each modifier criteria. Failure to ensure that these elements are present will result in decreased reimbursement for both the health care provider and the facility where the services have been provided.


Doug Arrington, Ph.D., FNP, CMC, CHC, CHRC, CPC-H, CPMA, Hayes Management Consulting


Do's and Don'ts of Using Modifier 59, XE, XS, XP, and XU

• Correct Usage of Modifier 59

• Clinical Real Life Examples of When to Use Modifiers XE, XS, SP, and XU

Review National Correct Coding Initiatives Edits for the Correct Application for Each Modifier

Apply This Knowledge to Clinical Documentation Scenarios to Different Clinical Specialties for Billing of Professional Services on HCFA 1500 Claim Forms

Apply This Knowledge to Clinical Documentation Scenarios From Different Facility Revenue Center for Billing of Facility Services on UB-04 Claim Forms

Tips on Working With Health Care Providers to Ensure That There Is Clinical Documentation to Support the Billing of These Clinical Services With These Modifiers