tci E/M Coding Alert - 2023 Issue Q4

Reader Question: Explore Circumstances for X{EPSU} Usage

Question: Can you explain when I should and shouldn’t use the X{EPSU} modifiers? Minnesota Subscriber Answer: It is appropriate to use the X{EPSU} modifiers when billing Medicare or payers following Medicare guidelines: For a different session or patient encounter, different surgery, different provider, different anatomical site, separate injury or area of injury, or an unusual non-overlapping service; or When the medical record documentation indicates two separate distinct procedures performed on the same day by the same physician. On the other hand, you should never use modifiers X{EPSU} under the following circumstances: If the code combination does not appear...

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