Q&A: When is modifier -XE appropriate to report?

Q: Our facility is used to reporting modifier -59 (distinct procedural service), but we're not sure when modifier -XE (separate encounter, a service that is distinct because it occurred during a separate encounter) would be appropriate instead. Could you provide an example?

A: According to CMS:

These modifiers, collectively referred to as -X{EPSU} modifiers, define specific subsets of the -59 modifier …. The -X{EPSU} modifiers are more selective versions of the -59 modifier so it would be incorrect to include both modifiers on the same line.

Only if no more descriptive modifier is available and the use of modifier -59 best explains the circumstances should this modifier be used.

Modifier -XE is used to indicate a separate surgical operative session on the same date of service or a distinct encounter after the patient has left the hospital or changed status or locations within the facility.

Example: 8 a.m. outpatient surgery and 8 p.m. outpatient surgery.

Modifier -XE would be appended to a procedure that would otherwise be bundled.

Example: Patient has an electrocardiogram (EKG) in the emergency department (ED) and is then changed to observation status, where a second EKG is performed.

Modifier -XE would be appended to one of the EKGs to explain that the patient’s status (e.g., location) has changed (note that this interpretation has not been clarified by CMS but is expected to be accepted for outpatient facilities’ use of modifier -XE).

Example: Multiple visits per day for antibiotic infusion are common, and reporting and paying multiple visits and services will not be an issue when payment for drug administration is made based on CPT code–specific data. When multiple initial infusion services are performed on the same date but during separate encounters, modifier ‑XE should be used.

Editor's note: This answer is an excerpt from "JustCoding's Guide to Modifiers: Hospital Outpatient Edition" by Susan E. Garrison, CHCA, CPC, CPC-H. This answer was provided based on limited information. Be sure to review all documentation specific to your own individual scenario before determining appropriate code assignment.

Need expert advice? Email your questions for consideration in the Revenue Cycle Daily Advisor. Note: We do not guarantee that all questions will be answered.