XP Modifier

Separate Practitioner, service that is distinct because it was performed by a different practitioner

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 XP 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

  • 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

Incorrect Use

  • 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

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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