Pediatric Coding Alert

Question: In the Vol. 19, no. 4 issue of Pediatric Coding Alert, a reader asked whether they can charge two copays on the same date. The article advised that practices can append the second visit with the XP modifier (Second service on same day by a different provider) appended. My understanding of the “X” series modifiers is that they replace/define modifier 59 (Distinct procedural service). In the modifier 59 description, it states it is to be used for “other than E/M services”. So I am a bit confused: Can XP/XE/XS/XU be appended to an E/M service?

Answer: You are correct – the “X” modifiers should be avoided for evaluation and management codes. Although insurers were initially unclear about whether these modifiers could be appended to the E/M series, recent transmittals from Medicare and Medicaid insurers have labeled E/M use as an “inappropriate usage” of the X modifiers such as XP. Therefore, you should only use the X modifiers when you’re reporting two procedures together.