Modifier XE: Separate encounter

When it is appropriate

Use XE when the column two service happened during a separate encounter from the column one service on the same date, such as a morning visit for one problem and an unrelated, unplanned return visit later that day for a different problem.

When it is not appropriate

Do not use XE when both services were part of the same single encounter, or when a visit was artificially split into two encounters on paper just to avoid a bundling edit.

CMS preference

Use XE over plain 59 whenever the distinguishing factor really is timing (a separate encounter), since CMS intends the X modifiers to replace 59 wherever they fit more precisely.

Denial codes that point at this modifier

The corrective actions we publish for these CARCs name modifier XE. Read the denial first: the modifier only helps where the edit and the documentation both support it.

• CO-97The benefit for this service is included in the payment/allowance for another service/procedure that has already been adjudicated.
• CO-236This procedure or procedure/modifier combination is not compatible with another procedure or procedure/modifier combination provided on the same day according to the National Correct Coding Initiative or workers compensation state regulations/fee schedule requirements.