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Modifier 77 vs. Modifier XP

January 25, 2017
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Question:

Would you have any insight into what would be the differences and why a coder would use the modifier 77 versus the modifier XP? They seem to be the same for me. I think of the XP modifier as being established for CCI instances, but if there are separate providers on a professional claim for a repeat/same service, it would not hit any CCI edit. So, would the XP be used more for facility claims where the provider is not specifically identified? But why not use the 77 modifier? Any help you can provide would be appreciated.

Answer: 

Modifier 77 — Repeat Procedure by Another Physician or Other Qualified Health Care Professional is used to indicate the procedure was repeated. The repeated procedure must be exactly the same as the first and be performed on the same day.

The following information may be found on the Wisconsin Physician Services (WPS) website. This link also contains examples for correct use of modifier 77.

http://www.wpsmedicare.com/j8macpartb/resources/modifiers/modifier-77.shtml

“Appropriate Usage

Append to the professional component of an X-Ray or EKG procedure when a different physician repeated the reading as the physician performing the initial interpretation believes another physician’s expertise is needed.

Append to the professional component of an X-Ray or EKG procedure when the patient has two or more tests and more than one physician provides the interpretation and report.

Append when billing for multiple services on a single day and the service cannot be quantity billed.”

Modifier XP – Separate Practitioner, A Service That Is Distinct Because It Was Performed By A Different Practitioner is a subset of modifier 59 and indicates a separate and distinct service, one that is not repeated and is performed by a different practitioner.

The following may be found in Transmittal 1422, Specific Modifiers for Distinct Procedural Services, August 15, 2014:

“The Centers for Medicare and Medicaid Services (CMS) is establishing four new Healthcare Common Procedure Coding System (HCPCS) modifiers to define subsets of the -59 modifier, a modifier used to define a “Distinct Procedural Service.” Currently, providers can use the -59 modifier to indicate that a code represents a service that is separate and distinct from another service with which it would usually be considered to be bundled….

CMS has defined four new HCPCS modifiers to selectively identify subsets of Distinct Procedural Services (-59 modifier) as follows:

XE – Separate Encounter, A Service That Is Distinct Because It Occurred During A Separate Encounter

XS – Separate Structure, A Service That Is Distinct Because It Was Performed On A Separate Organ/Structure

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.”

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