XE Modifier

Separate encounter, service that is distinct because it occurred during a separate encounter

Instructions

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 is used to identify procedures/services, other than E/M services, that are not normally reported together, but are appropriate under the circumstances. These procedures/services occur during a separate encounter.

This modifier was developed to provide greater reporting specificity in situations where modifier 59 was previously reported and may be used in lieu of modifier 59 whenever possible. Modifier 59 should only be used if no other more specific modifier is appropriate.

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.

Correct Use

  • Modifiers 59 or -XE are used appropriately when the procedures are performed in different encounters on the same day.
  • Another common use of modifiers 59 or -XE is for surgical procedures, non-surgical therapeutic procedures, or diagnostic procedures that are performed during different patient encounters on the same day and that cannot be described by one of the more specific NCCI PTP-associated modifiers - i.e., 24, 25, 27, 57, 58, 78, 79, or 91. Modifiers 59 or -XE should only be used if no other modifier more appropriately describes the relationship of the two procedure codes.
  • There are three other limited situations in which two services may be reported as separate and distinct because they are separated in time and describe non-overlapping services even though they may occur during the same encounter, i.e.:
    1. Modifiers 59 or -XE are used appropriately for two services described by timed codes provided during the same encounter only when they are performed sequentially.
    2. There is an appropriate use for modifier 59 that is applicable only to codes for which the unit of service is a measure of time (e.g., per 15 minutes, per hour).
    3. If two timed services are provided in time periods that are separate and distinct and not interspersed with each other (i.e., one service is completed before the subsequent service begins), modifiers 59 or -XE may be used to identify the services.
  • National Correct Coding Initiative (NCCI) edits are typically created to prevent the inappropriate billing of lesions and sites that should not be considered to be separate and distinct. Modifiers 59 or -XS should only be used to identify clearly independent services that represent significant departures from the usual situations described by the NCCI edit. The treatment of contiguous structures in the same organ or anatomic region does not generally constitute treatment of different anatomic sites.

Incorrect Use

  • Should not be appended to an E/M service
  • Should not be used inappropriately if the basis for its use is that the narrative description of the two codes is different
  • When another modifier is more appropriate (e.g. modifier 76 or 91)
  • Should not be used to bypass NCCI edits
  • Does not replace modifiers such as RT, LT, E1-E4, FA, F1-F9, TA, T1-T9, LC, LD, RC, LM, or RI

Example

Column 1 Code / Column 2 Code - 93015/93040

  • CPT Code 93015 - Cardiovascular stress test using maximal or submaximal treadmill or bicycle exercise, continuous electrocardiographic monitoring, and/or pharmacological stress; with physician supervision, with interpretation and report
  • CPT Code 93040 - Rhythm ECG, one to three leads; with interpretation and report

Modifiers 59 or -XE may be reported if the rhythm ECG is performed at a different encounter than the cardiovascular stress test. If a rhythm ECG is performed during the cardiovascular stress test encounter, CPT code 93040 should not be reported and Modifier 59 should not be used. Modifiers 59 or -XE are used appropriately when the procedures are performed in different encounters on the same day.

Reminders

Records must evidence a different session or patient encounter, different procedure or surgery, different site or organ system, or separate lesion, incision, excision, injury or area of injury

Documentation in the medical record must satisfy the criteria required by any NCCI-associated modifier that is used.

Resources

 

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