by Christine Woolstenhulme, QCC, QMCS, CPC, CMRS
January 28th, 2015
- Separate Encounter, A Service That Is Distinct Because It Occurred During A Separate Encounter
- Coding pairs are part of the National Correct Coding Initiative (NCCI) procedure to procedure edits
- Documentation indicates the services were provided during separate patient/provider encounter
- Use Modifier XE with the Column 2 procedure code in the NCCI files
- Use Modifier XE only when there is no other modifier to describe the situation
- Code pairs are not part of the NCCI procedure to procedure edits
- If another valid modifier exists to identify the separate services
- 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 does not support the services were provided during a separate patient/provider encounter
- The patient did not leave and come back for the secondary service
- Exact same procedure code performed twice on the same day
- Multiple administration of injections of the same drug
- Submitted with modifier 59
- NCCI listings can be found on the CMS Website
- Medicare considers two physicians in the same group with the same specialty performing services on the same day the same physician.
- Providers should evaluate other modifiers such as the RT/LT identifying right and left, F1 - F0 to identify fingers, T1-T0 to identify toes and E1-E4 to identify eyelids. Evaluate additional modifiers to determine appropriate usage.