In my previous post, I have shared about how to use XE modifier while coding medical charts in medical coding. In this post, I will tell you how the documentation of the report is given for applying XE modifier in coding. As we know, XE is modifier is used when there is different encounter by the same patient on same day with the same physician. So, we will check it out with the sample reports for using XE modifier for coding live charts. Below the list of our new X modifiers.

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

XS Separate Structure, A Service That Is Distinct Because It Was Performed On A Separate Organ/Structure,

XP Separate Practitioner, A Service That Is Distinct Because It Was Performed By A Different Practitioner, and

XU Unusual Non-Overlapping Service, The Use Of A Service That Is Distinct  Because It Does Not Overlap Usual Components Of The Main Service.

Read also: When to use 25 and 27 modifier

First Report or First Encounter for XE modifier

Exam: THREE VIEWS OF THE RIGHT WRIST.

Time: 5/6/2015 7:22:56

Reason for Exam: Pain

Radiology

FINDINGS: There are comminuted and displaced fractures involving the distal radial metaphysis and epiphysis, fracture extends to the distal articular surface, where there is approximately 5.3 mm of distraction of the fracture site. No carpal bone fracture is identified.

So, here in the above report patient has come with a pain and the physician find a fracture in the distal radial metaphysic and epiphysis. The procedure code for the above report will be 73110-RT.

Read also: Awesome tips for coding modifiers in Medical coding

 Second Report or Second Encounter for XE modifier

EXAM: DX Wrist 2 Views RT

Time: 5/6/2015 9:12:54

Reason for Exam: post reduction

Radiology

Findings: Two postreduction views of the right wrist demonstrate decreased displacement of the comminuted fracture of the distal radial metaphysis and epiphysis, the fracture line at the distal articular surface now has approximately 1 mm or less of displacement. There is no carpal bone fracture or dislocation.

Cast has been placed

Now, in the above second encounter the patient again comes after two hours to the same physician for the reduction of the fracture. Now, the procedure code for the second encounter is 73100-RT. So, there is difference in levels in procedures hence there will be CCI edit between these two procedure codes. Hence, here in such situation we will use X-Encounter modifier to differentiate between these two procedures for different encounter. So, the final CPT code will be 73100-RT,XE.

Read also: When to use modifier 58, 78 and 79

Points to remember for using XE modifier

Modifier 59 should not be used when one of the -X{EPSU} modifiers describes the reason for the distinct procedural service. The -X{EPSU} modifiers are more specific versions of the -59 modifier.

It is not appropriate to bill both modifier 59 and a -X{EPSU} modifier on the same line.  CPT codes submitted with modifiers XE, XP, XS, XU, or 59 appended will be considered separately reimbursable when all of the following apply:

The medical records documentation supports the appropriate use of modifiers XE, XP, XS, XU, or 59

The procedure code is eligible for separate reimbursement according to the status indicators on the CMS fee schedule for the relevant provider type (physician fee schedule, ASC, OPPS, etc.).