Modifier Coding Alert

Published on Fri Sep 19, 2014 PDF

Question: We have a patient experiencing symptomatic bradycardia, atrial fibrillation with syncope present. A pacemaker was inserted. Is there a need for a modifier?

Georgia Subscriber

Answer: Yes, you would attach modifier KX (Requirements specified in the medical policy have been met) for a single or dual chamber pacemaker insertions (33206-33208, Insertion of new or replacement of permanent pacemaker with transvenous electrode[s]; …).

MACs will pay professional claims for implanted permanent cardiac pacemakers, single chamber or dual chamber, provided the claim meets the following criteria:

• The claim includes at least one of the CPT® codes of 33206 (…; atrial), 33207 ( … ; ventricular), or 33208 ( … ; atrial and ventricular) 
• The claim includes at least one ICD-9-CM/ICD-10-CM diagnostic code
• The claim is submitted with the KX modifier.

Note: “MACs will accept the inclusion of the KX modifier on the claim line(s) as an attestation by the provider of the service that documentation is on file verifying the patient has non-reversible symptomatic bradycardia (symptoms of bradycardia are symptoms that can be directly attributable to a heart rate less than 60 beats per minute [for example syncope, seizures, congestive heart failure, dizziness, or confusion]),” according to CMS MLN Matters MM8525.