Last week, we briefly described the X modifier series and when to substitute these new modifiers. Below are a few scenarios from the NCCI policy manual you can refer to when using these modifiers.*

  • The CCI bundle involving column 1 code 45385 (Flexible colonoscopy with removal of tumor[s], polyp[s], or lesion[s] by snare technique) and column 2 code 45380 (Flexible colonoscopy with single or multiple biopsies) with one of the four X modifiers. However, note the exact CCI guidance: “The use of modifier XS is only appropriate if the two procedures are performed on separate lesions. Use of modifier XE is only appropriate if the two procedures are performed at separate patient encounters. The documentation shall not be reported with a code for the same lesion”.
  • Generally, providers shall not report more than one physical medicine and rehabilitation therapy service for the same 15-minute time period. You’ll find that some CCI edits pair a timed CPT code with another timed, or non-timed, CPT. These edits can be bypassed “with modifier 59 or XU if the two procedures of a code pair edit are performed in different timed intervals even if sequential during the same patient encounter”.
  • The primary graft and skin substitute codes are mutually exclusive since only one type of graft or skin substitute can be used at a single anatomic site. If multiple sites require different types of grafts, use modifier XS to indicate the different sites.
  • You should not report HCPCS code J3471 (Injection, hyaluronidase, ovine, preservative-free, per 1 USP unit [up to 999 units]) with more than 999 units of service (UOS). If you report more than 999 units of the product described by J3471, you “may report HCPCS code J3471 on more than one line of a claim appending modifier XU to additional claim lines and should report no more than 999 UOS on any one claim line”.
  • You can report a diagnostic procedure in cases where the procedure’s findings necessitate a therapeutic response. “A diagnostic procedure is performed on a 60-year-old male complaining of chest pains. Due to the findings, a physician’s decision is then made to perform a therapeutic/surgical procedure. When the diagnostic cardiac angiography leads to a therapeutic angioplasty, use XU as the modifier.”

*As with all code reporting, be sure to check with individual payers on their policy regarding the X modifier series.