Wiki Correct use of modifier XE

[hsmith67]

CMS introduced X (E, U, S, P) 1/1/15. I am being told it is correct to use modifier XE in place of 59 in the following situations:

1) Established out patient is seen for a problem visit and has an EKG done. Bill as 9921"x" and 93000-XE (NOTE, the EKG was done during the same encounter, patient came into office only once during the day).

2) Established out patient visit is seen for flu like symptoms. Bill as 9921"x", 87804-QW, AND 87804-QW-XE (NOTE, the visit and flu test were done during the same visit/encounter, patient only came to office one time during the date of service).

Please provide any helpful information on correct use of modifier XE if the above is not correct use, examples of correct use of XE would be greatly appreciated if the above is not correct.

Thanks very much!

Hunter Smith, CPC

 

[thomas7331]

I believe you've been given incorrect information - XE is defined as 'separate encounter', and in your examples above you've indicated services were performed on the same encounter, so this would not be correct use of the modifier. A separate encounter would indicate that the patient left the office or facility but returned again at a different time that day - so two distinct encounters with the provider on the same date. The modifier would be used to unbundle two procedures that would not normally be reported separately because they are mutually exclusive or one is a component of the other, but in this case are separately coded because they were given or performed at completely different patient encounters that day.

 

[hsmith67]

modifier XE use

I believe you've been given incorrect information - XE is defined as 'separate encounter', and in your examples above you've indicated services were performed on the same encounter, so this would not be correct use of the modifier. A separate encounter would indicate that the patient left the office or facility but returned again at a different time that day - so two distinct encounters with the provider on the same date. The modifier would be used to unbundle two procedures that would not normally be reported separately because they are mutually exclusive or one is a component of the other, but in this case are separately coded because they were given or performed at completely different patient encounters that day.

Thomas,
Thanks! I understood it the exact same way as you, your answer helped resolve a debate.

Thanks again!
Hunter Smith, CPC