Modifier XE

Definition

Separate Encounter, A Service That Is Distinct Because It Occurred During A Separate Encounter

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 during separate patient/provider encounter
  • 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 separate services
  • 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 during a separate patient/provider encounter
    • Patient did not leave and come back for secondary service
  • Exact same procedure code performed twice on same day
  • Multiple administration of injections of same drug
  • Submitted with modifier 59

Additional Information

 

Last Updated Fri, 28 Feb 2020 13:03:49 +0000