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This month’s selection:

I have a coding question from a Professional Coding perspective. Is it appropriate to use modifier XE with a modifier 76 or 77? Are there any official guidelines around the use of the X modifiers and when it is and is not appropriate to use them?

Dusty Poole, RHIA, CPC
Texas Children’s Hospital

Response:

Modifiers 76/77 indicate that the exact same procedure was performed on the same day. The X modifiers are used for separate and distinct services. Therefore, if the modifiers 76/77 are appropriate, it would be incorrect to report the X modifiers as well.

See below:

The X modifiers would be appropriate to use when the documentation indicates two separate procedures performed on the same day by the same physician or a different session or patient encounter, different procedure or surgery, different site, or separate injury (or area of injury). They would not be appropriate to use when the exact same procedure was performed twice on the same day, which is the scenario in which modifier 76/77 would be used.

The X modifiers, much like the 59 modifier they replaced, should not to be used in the following situations:

• code combinations do not appear in the Corrective Coding Initiative edits;
• submission of evaluation & management codes;
• submission of weekly radiation therapy management codes (CPT 77427);
• Medicare Physician Fee Schedule Database lists the procedure code with a modifier indicator of “0”;
• documentation does not support the separate and distinct status;
• the exact same procedure code was performed twice on the same day; or
• a valid modifier exists to identify the service.

Modifier 76 is used in the following situations:

• procedure codes cannot be quantity billed;
• each service is on a separate line, using a quantity of one and appending 76 to the subsequent procedures; or
• the same physician performs the services.

In addition, for reference, the Medicare Administrative Contractor (MAC) Wisconsin Physicians Service Insurance Corporation (WPS) clearly states that if another modifier applies, the X modifiers should not be used.

Therefore, it appears they assert that the two should not be reported together. If WPS is not your MAC, it is always advisable to check with your MAC for further guidance.

www.wpsmedicare.com/j5macparta/resources/modifiers/index.shtml

— Yvette DeVay is an outpatient coding consultant for Craneware.