Modifier XE Fact Sheet

Definition

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

Appropriate Usage

• 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

Inappropriate Usage

• 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

Additional Information

• 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.

Example:

Distinctly different Column 1/ Column 2 CCI Edit

Modifier reported incorrectly for CCI edit

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