Definition

Separate Practitioner, A Service That Is Distinct Because It Was Performed By A Different Practitioner

Appropriate Usage

• Append when coding pairs are part of National Correct Coding Initiative (NCCI) procedure to procedure edits
• Append when documentation indicates services were provided by different practitioners with same specialty in same group practice
• Append to Column 2 procedure code in NCCI files
• Append only when there is no other modifier to describe situation

Inappropriate Usage

• Appending when code pairs are not part of NCCI procedure to procedure edits
• Appending if another valid modifier exists to identify performance of services by different practitioners
• Submission of E/M Codes
• Submission of Weekly radiation therapy management codes (CPT 77427)
• Appending when NCCI code files show modifier application as "0"
• Appending when documentation does not support services were provided by different practitioners
• Exact same procedure code performed twice on same day
• Multiple administration of injections of same drug
• Submitted with Modifier 59

Additional Information

• National Correct Coding Initiative Edits
• CMS Change Request (CR) 8863 - Specific Modifiers for Distinct Procedural Services
• MLN Fact Sheet Proper Use of Modifiers 59 & –X{EPSU}