Did you know modifier XE was introduced to reduce the misuse of modifier 59? We all know medical billing isn’t as simple as listing your services to get payments. In reality, you must communicate the context in which you delivered those services to insurance companies. Modifiers help you with that!
Unfortunately, some modifiers, such as modifier 59, are under constant scrutiny due to inappropriate application. That’s where the XE modifier comes in. As part of the X{EPSU} modifiers introduced by the Centers for Medicare and Medicaid Services (CMS), this powerful code provides more specificity, helping you report separate encounters. Let’s get into its details!
XE Modifier – Description
As we mentioned in the intro, the XE modifier in medical billing refers to separate encounters. But what does it actually mean? This modifier specifies that a service or procedure was performed at a different patient encounter but on the same day as other services.
Simply put, it indicates that the performed service, including surgical, non-surgical therapeutic, or diagnostic procedure, is distinct specifically because it occurred at a different session. This small yet powerful code is considered an HCPCS modifier because it was introduced by the CMS, unlike CPT modifiers introduced by the American Medical Association (AMA).
In short, modifier XE is one of the four NCCI PTP-associated modifiers that offer greater reporting specificity in describing medical services than modifier 59.
Scenarios Where an XE Modifier is Applicable
So, what are the specific scenarios in which you can use modifier XE? Before moving on to real-world examples, keep in mind that you should only use this code if no other modifier, such as 24, 25, or 27, can describe distinct services during different patient encounters. Here are a few modifier XE examples so you can confidently apply this modifier:
Ultrasonic Guidance Procedure During a Separate Encounter
Suppose a 34-year-old woman is admitted to a hospital to treat her liver tumor. The surgeon performs a minimally invasive laparoscopy procedure (CPT code 47370) via radiofrequency ablation to destroy one or more tumors in the patient’s liver.
Following this procedure, the surgeon focuses on a suspicious adjacent tissue during a separate encounter. He performs a needle biopsy (CPT code 76942) to collect tissue or fluid samples using ultrasonic guidance later in the evening. Since this procedure occurred during a different encounter, the doctor appends modifier XE to the corresponding CPT code.
The coding for these two procedures is as follows:
- Column 1 Code: 47370
- Column 2 Code: 76942-XE
ECG During a Different Session
Still uncertain about modifier XE? Let’s consider another example. A 42-year-old man visits a cardiologist to receive clearance for a new exercise routine. The doctor orders a complete cardiovascular stress test (CPT code 93015) via a maximal treadmill to monitor the patient’s heart activity. The cardiologist takes electrocardiogram (ECG) readings at regular intervals, interprets the data, and clears the patient to proceed with the exercise plan.
However, the patient returns later in the evening due to an abnormal heart rhythm. The same cardiologist performs a rhythm ECG (CPT code 93040) to check for abnormalities. Since the ECG is performed during a separate encounter from the cardiovascular stress test, the billing team reports its CPT code with modifier XE.
- Column 1 Code: 93015
- Column 2 Code: 93040-XE
Distinct Surgical Procedures at Different Encounters
We have already covered minimally invasive and diagnostic procedures. Let’s also consider a surgical scenario for the correct application of modifier XE.
Suppose a patient with an infected appendix undergoes an appendectomy (CPT code 44950) in the morning. After the surgery, the doctor transfers the patient to the recovery room. However, the doctor is called back to the operating room later at night on the same day to reopen the patient’s abdomen (CPT code 49002) due to internal bleeding.
Since this second procedure is distinct from an appendectomy and performed during a separate encounter, the billing team uses modifier XE with CPT code 49002.
- Column 1 Code: 44950
- Column 2 Code: 49002-XE
Modifier XE – Billing Guidelines
Like procedural codes, you should also understand the purpose of each modifier to avoid penalties and denials. For billing accuracy, follow the key billing guidelines for this modifier.
Understand Modifier XE‘s Key Purpose & Identify Qualifying Scenarios
Use this modifier only to specify separate encounters on the same date of service. Simply put, understand the purpose of this two-character code before using it in medical claims to avoid partial payments or denials.
To simplify, you can use this modifier in two conditions:
- When a patient has multiple encounters with the same provider on the same day.
- When the service or procedure, performed at a separate session, is distinct or separately identifiable from other services provided on the same day.
Check the NCCI PTP Edits
Keep one thing in mind when using this modifier. You should never use modifier XE to bypass NCCI Procedure-to-Procedure (PTP) edits unless it meets the proper criteria. Always check the Correct Coding Modifier Indicator (CCMI) values before filing any claim.
If you report two procedural codes with a CCMI of 0, Medicare will only reimburse the initial service (the code in Column 1) and deny the reimbursement request for the Column 2 code.
Maintain Proper Documentation
Insurance companies rely on documentation to verify that the medically necessary services were indeed performed during different sessions. Therefore, maintain comprehensive records, including:
- Time and date of each encounter
- Reason for each visit
- Provided services
In short, your documentation must demonstrate that the services or procedures performed during separate encounters were unrelated.
Apply Modifier XE to the Correct Code
Coding accuracy is essential for receiving timely and fair reimbursements. Therefore, pay close attention to procedural codes and apply modifier XE to the service provided during a different session. This is usually a service that is performed later. Many healthcare providers face claim denials because they mistakenly apply this modifier to the wrong code.
Avoid Common Mistakes
We have mentioned the qualifying criteria to help you bypass the most basic mistakes. Avoid using modifier XE when:
- Performed services are related to each other
- Services are performed during the same patient encounter
- Services are part of the same procedure or bundled
Comply with Payer-Specific Guidelines
Keep an eye on payer-specific rules and regulations, as some insurers may have unique restrictions. In addition to checking NCCI PTP edits, review each insurer’s guidelines for using this modifier accurately. Most importantly, regularly visit the CMS website to stay updated and avoid audits or penalties.
Train Your Staff
Finally, our consistent advice is to train your staff on when and how to use each code and modifier. Besides your billing team, educate your clinical staff on the correct application of modifier XE. You can provide real-life examples, just as we did in this blog, and conduct regular audits to maintain compliance.
Modifier XE vs. 59
So, how does modifier XE differ from modifier 59? Let’s understand their two key differences:
Purpose
Modifier 59 helps insurance companies identify distinct or independent services from other non-E/M procedures performed on the same day. In short, you can use this two-digit code to report procedures/services that are usually not billed together. Unfortunately, modifier 59 is under constant scrutiny due to inappropriate use.
So, what is the better alternative for reporting distinct services performed during separate sessions? You can use the modifier XE to report multiple unrelated encounters.
Specificity
Modifier 59 is less specific than modifier XE. It only indicates distinct non-E/M services performed by the same physician on the same day. On the other hand, as one of the X{EPSU} codes, modifier XE provides additional context about the performed service, specifying that it is distinct because it occurred at a separate encounter.
Summary
To summarize, CMS introduced the XE modifier in medical billing, along with XS, XP, and XU, to reduce fraudulent billing. This two-character code is known for being more specific, reducing the chance of claim denials and penalties. You can use the modifier XE to receive separate payments for services performed during different sessions.
We have thoroughly covered all the details of this modifier in our blog, including a simplified description, real-world examples, billing guidelines, and key differences from modifier 59, so you can use it correctly.
