Modifier XE Fact Sheet - Chiropractic Coding and Billing

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

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

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

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.