Neurology & Pain Management Coding Alert

Question: Can you explain when I should and shouldn’t use the X{EPSU} modifiers?

Michigan Subscriber

Answer: First, here’s a list of the X{EPSU} modifiers:

• XE (Separate encounter, a service that is distinct because it occurred during a separate encounter): Use this if the provider performs bundled procedures during separate encounters on the same date of service.
• XS (Separate structure, a service that is distinct because it was performed on a separate organ/structure): If the provider performs bundled services on distinct anatomic sites or possibly on distinctly different sections of one anatomic site, this modifier is a more specific choice than 59.
• 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)

It is appropriate to use the X{EPSU} modifiers when billing Medicare or payers following Medicare guidelines in the following situations:

• For a different session or patient encounter, different surgery, different provider, different anatomical site, separate injury or area of injury, or an unusual non-overlapping service; or
• When the medical record documentation indicates two separate distinct procedures performed on the same day by the same physician.

On the other hand, you should never use modifiers X{EPSU} under the following circumstances:

• If the code combination does not appear in the National Correct Coding Initiative (NCCI) edits;
• If the edit pair has a modifier indicator of 0, you cannot use a modifier to break the edit;
• If the medical record documentation does not support the separate and distinct status;
• If the provider performed the exact same procedure twice on the same day; instead, you should look to modifier 76 (Repeat procedure or service by same physician or other qualified health care professional) or 77 (Repeat procedure or service by another physician or other qualified health care professional); and
• You should not append these modifiers to an evaluation and management (E/M) service performed on the same date. In that case, you should apply an E/M modifier such as 25 (Significant, separately identifiable evaluation and management service by the same physician or other qualified health care professional on the same day of the procedure or other service).

The X{EPSU} modifiers give greater reporting specificity in situations where you used modifier 59 (Distinct procedural service) previously. Append these modifiers instead of 59 whenever possible. Only use modifier 59 if no other more specific modifier is appropriate.

Note: Documentation is key when you are using modifiers. The supporting documentation must satisfy the criteria required.