XU - JF Part A

Definition

Unusual Non-Overlapping Service, The Use Of A Service That Is Distinct Because It Does Not Overlap Usual Components Of The Main Service

Appropriate Usage

• Append when coding pairs are part of National Correct Coding Initiative (NCCI) procedure to procedure edits
• Append when documentation indicates service was not part of usual components of main service
• Append to Column 2 procedure code in NCCI files
• Append only when there is no other modifier to describe situation

Inappropriate Usage

• Code pairs are not part of the NCCI procedure to procedure edits
• If another valid modifier exists to identify the service does not overlap the usual components of the main service - the column 1 procedure code
• Submission of E/M Codes
• Submission of Weekly radiation therapy management codes (CPT 77427)
• The NCCI code files show the modifier application as "0"
• Documentation supports the service is a component of the main service
• Exact same procedure code performed twice on the same day
• Multiple administration of injections of the 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}