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

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.