Examples of When to Use Modifier XE

March 16, 2015
Rick Gawenda

Currently, providers can use the -59 modifier to indicate that a code represents a service that is separate and distinct from another service with which it would usually be considered to be bundled. The primary issue associated with the -59 modifier is that it is defined for use in a wide variety of circumstances, such as a use to identify different encounters, different anatomic sites, and distinct services. Usage to identify a separate encounter is infrequent and usually correct; usage to define a separate anatomic site is less common and problematic; usage to define a distinct service is common and not infrequently overrides the edit in the exact circumstance for which the Centers for Medicare and Medicaid Services (CMS) created the edit in the first place. The CMS has established 4 new subsets of modifier 59 to combat the abuse of Modifier 59 and to better understand why providers utilize modifier 59. In this post, I will provide 3 examples of when the XE modifier would be appropriate to use. The definition of Modifier XE is

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  1. Rick:
    I guess that an OBS pt on the acute floors, the example of proper XE use would be the same.
    Thomas Hartigan, OT/L, Director

  2. Hi Rick, How does the SLP example under XU and this XE example differ?
    Also if during the same treatment session the PT provides 97530 and 97116. Would you apply the XE or XU? How does CMS define “Encounter”?
    Thank you!