• Separate Encounter, A Service That Is Distinct Because It Occurred During A Separate Encounter

Appropriate Usage

  • Coding pairs are part of the National Correct Coding Initiative (NCCI) procedure to procedure edits
  • Documentation indicates the services were provided during separate patient/provider encounter
  • Use Modifier XE with the Column 2 procedure code in the NCCI files
  • Use Modifier XE only when there is no other modifier to describe the situation

Inappropriate Usage

  • Code pairs are not part of the NCCI procedure to procedure edits
  • If another valid modifier exists to identify the separate services
  • 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 does not support the services were provided during a separate patient/provider encounter
    • The patient did not leave and come back for the secondary service
  • Exact same procedure code performed twice on the same day
  • Multiple administration of injections of the same drug
  • Submitted with modifier 59

Additional Information

  • NCCI listings can be found on the CMS Website
  • Medicare considers two physicians in the same group with the same specialty performing services on the same day the same physician.
  • Providers should evaluate other modifiers such as the RT/LT identifying right and left, F1 - F0 to identify fingers, T1-T0 to identify toes and E1-E4 to identify eyelids. Evaluate additional modifiers to determine appropriate usage.

Modifier XE Fact Sheet