Anesthesia Coding Alert

Question: I have a question regarding the new modifiers (XE, XS, XP, and XU) that can sometimes replace modifier 59. When do we use (or not use) the new modifiers?

California Subscriber 

Answer: CMS has defined four new HCPCS modifiers to selectively identify subsets of Distinct Procedural Services (-59 modifier).

CMS will continue to recognize the -59 modifier in many instances, but may selectively require a more specific X{EPSU} modifier for billing certain codes at high risk for incorrect billing. For example, a particular NCCI code pair may be identified as payable only with the -XE separate encounter modifier but not the -59 or other X{EPSU} modifiers.

As a refresher, the new modifier possibilities are:  

• 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)
• XU: Unusual non-overlapping service (The use of a service that is distinct because it does not overlap usual components of the main service).