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. The new subsets of modifier 59 became effective January 1, 2015 and providers can use them now instead of modifier 59 with Medicare; however, they are not mandated for use as of the posting of this article. In this article, I will provide 4 examples of when the XE modifier would be appropriate to use. The definition of Modifier XE is Separate Encounter, A Service That Is Distinct Because It Occurred During A Separate Encounter. The examples are as follows:
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This article is not intended to and does not serve as legal advice or as consultative services, but is for general information purposes only.