CCO Admin asked:
does anyone know of any examples i can find for x modifiers
for medicare https://www.youtube.com/watch?v=f_uQbX1NvQw&t=28s; https://www.youtube.com/watch?v=8BXiCCNr8ak; https://www.cms.gov/outreach-and-education/medicare-learning-network-MLN/mlnmattersarticles/downloads/mm8863.pdf; https://www.cms.gov/Medicare/Coding/NationalCorrectCodInitEd/downloads/modifier59.pdf; https://www.aapc.com/blog/45862-new-rules-issued-for-modifiers-59-xe-xs-xp-and-xu/
Answer:
CR8863 provides that CMS is establishing the following four new HCPCS modifiers (referred to collectively as -X{EPSU} modifiers) to define specific subsets of the -59 modifier:
**? XE Separate Encounter; A Service That Is Distinct Because It Occurred During A Separate Encounter;**
## Modifier XE
### Definition
Separate Encounter; A Service That Is Distinct Because It Occurred During A Separate Encounter
### Appropriate Usage
* Append when coding pairs are part of National Correct Coding Initiative (NCCI) procedure to procedure edits
* Append when documentation indicates services were provided during separate patient/provider encounter
* Append to Column 2 procedure code in NCCI files
* Append only when there is no other modifier to describe situation
### Inappropriate Usage
* Appending when code pairs are not part of NCCI procedure to procedure edits
* Appending if another valid modifier exists to identify separate services
* Submission of E/M Codes
* Submission of Weekly radiation therapy management codes (CPT 77427)
* Appending when NCCI code files show modifier application as "0"
* Appending when documentation does not support services were provided during a separate patient/provider encounter
* Patient did not leave and come back for secondary service
* Exact same procedure code performed twice on same day
* Multiple administration of injections of same drug
* Submitted with modifier 59
**? XS Separate Structure; A Service That Is Distinct Because It Was Performed On A Separate Organ/Structure;**
## Modifier XS
### Definition
Separate Structure; A Service That Is Distinct Because It Was Performed on A Separate Organ/Structure
### Appropriate Usage
* Append when coding pairs are part of National Correct Coding Initiative (NCCI) procedure to procedure edits
* Append when documentation indicates services were provided on different organs/structures
* Append to Column 2 procedure code in NCCI files
* Append only when there is no other modifier to describe situation
### Inappropriate Usage
* Appending when code pairs are not part of the NCCI procedure to procedure edits
* Appending if another valid modifier exists to identify separate services
* Submission of E/M Codes
* Submission of Weekly radiation therapy management codes (CPT 77427)
* NCCI code files show modifier application as "0"
* Appending when documentation does not support the services were provided on a separate organ/structure
* Example: both procedures were performed on liver during a single encounter
* Exact same procedure code performed twice on same day
* Multiple administration of injections of same drug
* Submitted with Modifier 59
**? XP Separate Practitioner; A Service That Is Distinct Because It Was Performed By A Different Practitioner; and**
## Modifier XP
### Definition
Separate Practitioner; A Service That Is Distinct Because It Was Performed By A Different Practitioner
### Appropriate Usage
* Append when coding pairs are part of National Correct Coding Initiative (NCCI) procedure to procedure edits
* Append when documentation indicates services were provided by different practitioners with same specialty in same group practice
* Append to Column 2 procedure code in NCCI files
* Append only when there is no other modifier to describe situation
### Inappropriate Usage
* Appending when code pairs are not part of NCCI procedure to procedure edits
* Appending if another valid modifier exists to identify performance of services by different practitioners
* Submission of E/M Codes
* Submission of Weekly radiation therapy management codes (CPT 77427)
* Appending when NCCI code files show modifier application as "0"
* Appending when documentation does not support services were provided by different practitioners
* Exact same procedure code performed twice on same day
* Multiple administration of injections of same drug
* Submitted with Modifier 59
**? XU Unusual Non-Overlapping Service; The Use Of A Service That Is Distinct Because It Does Not Overlap Usual Components Of The Main Service**.
## Modifier XU
### 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
does anyone know of any examples i can find for x modifiers
for medicare https://www.youtube.com/watch?v=f_uQbX1NvQw&t=28s; https://www.youtube.com/watch?v=8BXiCCNr8ak; https://www.cms.gov/outreach-and-education/medicare-learning-network-MLN/mlnmattersarticles/downloads/mm8863.pdf; https://www.cms.gov/Medicare/Coding/NationalCorrectCodInitEd/downloads/modifier59.pdf; https://www.aapc.com/blog/45862-new-rules-issued-for-modifiers-59-xe-xs-xp-and-xu/
Answer:
CR8863 provides that CMS is establishing the following four new HCPCS modifiers (referred to collectively as -X{EPSU} modifiers) to define specific subsets of the -59 modifier:
**? XE Separate Encounter; A Service That Is Distinct Because It Occurred During A Separate Encounter;**
## Modifier XE
### Definition
Separate Encounter; A Service That Is Distinct Because It Occurred During A Separate Encounter
### Appropriate Usage
* Append when coding pairs are part of National Correct Coding Initiative (NCCI) procedure to procedure edits
* Append when documentation indicates services were provided during separate patient/provider encounter
* Append to Column 2 procedure code in NCCI files
* Append only when there is no other modifier to describe situation
### Inappropriate Usage
* Appending when code pairs are not part of NCCI procedure to procedure edits
* Appending if another valid modifier exists to identify separate services
* Submission of E/M Codes
* Submission of Weekly radiation therapy management codes (CPT 77427)
* Appending when NCCI code files show modifier application as "0"
* Appending when documentation does not support services were provided during a separate patient/provider encounter
* Patient did not leave and come back for secondary service
* Exact same procedure code performed twice on same day
* Multiple administration of injections of same drug
* Submitted with modifier 59
**? XS Separate Structure; A Service That Is Distinct Because It Was Performed On A Separate Organ/Structure;**
## Modifier XS
### Definition
Separate Structure; A Service That Is Distinct Because It Was Performed on A Separate Organ/Structure
### Appropriate Usage
* Append when coding pairs are part of National Correct Coding Initiative (NCCI) procedure to procedure edits
* Append when documentation indicates services were provided on different organs/structures
* Append to Column 2 procedure code in NCCI files
* Append only when there is no other modifier to describe situation
### Inappropriate Usage
* Appending when code pairs are not part of the NCCI procedure to procedure edits
* Appending if another valid modifier exists to identify separate services
* Submission of E/M Codes
* Submission of Weekly radiation therapy management codes (CPT 77427)
* NCCI code files show modifier application as "0"
* Appending when documentation does not support the services were provided on a separate organ/structure
* Example: both procedures were performed on liver during a single encounter
* Exact same procedure code performed twice on same day
* Multiple administration of injections of same drug
* Submitted with Modifier 59
**? XP Separate Practitioner; A Service That Is Distinct Because It Was Performed By A Different Practitioner; and**
## Modifier XP
### Definition
Separate Practitioner; A Service That Is Distinct Because It Was Performed By A Different Practitioner
### Appropriate Usage
* Append when coding pairs are part of National Correct Coding Initiative (NCCI) procedure to procedure edits
* Append when documentation indicates services were provided by different practitioners with same specialty in same group practice
* Append to Column 2 procedure code in NCCI files
* Append only when there is no other modifier to describe situation
### Inappropriate Usage
* Appending when code pairs are not part of NCCI procedure to procedure edits
* Appending if another valid modifier exists to identify performance of services by different practitioners
* Submission of E/M Codes
* Submission of Weekly radiation therapy management codes (CPT 77427)
* Appending when NCCI code files show modifier application as "0"
* Appending when documentation does not support services were provided by different practitioners
* Exact same procedure code performed twice on same day
* Multiple administration of injections of same drug
* Submitted with Modifier 59
**? XU Unusual Non-Overlapping Service; The Use Of A Service That Is Distinct Because It Does Not Overlap Usual Components Of The Main Service**.
## Modifier XU
### 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
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