XS Modifier

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

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 -XS are used appropriately for different anatomic sites during the same encounter only when procedures which are not ordinarily performed or encountered on the same day are performed on different organs, or different anatomic regions, or in limited situations on different, non-contiguous lesions in different anatomic regions of the same organ.
  • Modifiers 59 or -XS are for surgical procedures, non-surgical therapeutic procedures, or diagnostic procedures that are performed at different anatomic sites, are not ordinarily performed or encountered on the same day, and that cannot be described by one of the more specific anatomic NCCI PTP-associated modifiers -that is, RT, LT, E1-E4, FA, F1-F9, TA, T1-T9, LC, LD, RC, LM, or RI. From a National Correct Coding Initiative (NCCI) perspective, the definition of different anatomic sites includes different organs or, in certain instances, different lesions in the same organ. However, 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, 77 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

Examples

Example 1: Column 1 Code / Column 2 Code - 11102/17000

  • CPT Code - 11102 Tangential biopsy of skin (e.g., shave, scoop, saucerize, curette); single lesion
  • CPT Code 17000 - Destruction (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), premalignant lesions (eg, actinic keratoses); first lesion

Modifiers 59 or -XS may be reported with code 17000 if the procedures are performed at different anatomic sites on the same side of the body and a specific anatomic modifier is not applicable. If the procedures are performed on different sides of the body, modifiers RT and LT or another pair of anatomic modifiers should be used, not modifiers 59 or -XS.

Modifiers 59 or -XS are used appropriately for different anatomic sites during the same encounter only when procedures which are not ordinarily performed or encountered on the same day are performed on different organs, or different anatomic regions, or in limited situations on different, non-contiguous lesions in different anatomic regions of the same organ.

Example 2: Column 1 Code / Column 2 Code - 11055/11720

  • CPT Code 11055 - Paring or cutting of benign hyperkeratotic lesion (eg, corn or callus); single lesion
  • CPT Code 11720 - Debridement of nail(s) by any method(s); one to five

CPT codes 11720 and 11055 should not be reported together for services performed on skin distal to and including the skin overlying the distal interphalangeal joint of the same toe. Modifiers 59 or -X{EPSU} should not be used if a nail is debrided on the same toe on which a hyperkeratotic lesion of the skin on or distal to the distal interphalangeal joint is pared. Modifiers 59 or -XS may be reported with code 11720 if one to five nails are debrided and a hyperkeratotic lesion is pared on a toe other than one with a debrided toenail or the hyperkeratotic lesion is proximal to the skin overlying the distal interphalangeal joint of a toe on which a nail is debrided.

Example 3: Column 1 Code / Column 2 code - 67210/67220

  • CPT Code 67210 - Destruction of localized lesion of retina (eg, macular edema, tumors), 1 or more sessions; photocoagulation
  • CPT Code 67220 - Destruction of localized lesion of choroid (eg, choroidal neovascularization); photocoagulation (eg, laser), 1 or more sessions

CPT code 67220 should not be reported and Modifier 59 or -X{EPSU} should not be used if both procedures are performed during the same operative session because the retina and choroid are contiguous structures of the same organ.

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

 

Last Updated Tue, 24 Nov 2020 19:28:01 +0000