Revenue Cycle Insider

Question: I am relatively new to podiatry coding, and I am trying to determine if the KX modifier is being used correctly on durable medical equipment (DME) claims by our practice as we have had some recent recoupments. Can you explain when the KX modifier should be used when billing DME?

AAPC Forum Participant

Answer: Without having specific codes in your question, we can only share some general information as to how the KX (Requirements specified in the medical policy have been met) modifier is used on some DME claims in relation to podiatry. Medicare and Medicare Advantage plans require modifier KX on all claims containing braces, boots, shoes, etc. When you add the modifier KX to the claim, you are essentially telling the payer that you have all the documents or information required to dispense this item to the patient. It also tells them that you have met medical necessity.

Some of these items have very specific documentation requirements, such as shoes and custom orthotics, which can only be dispensed a few times a year in most cases. If you have been getting denials from Medicare plans, it could be due to something like the patient already receiving the same or a similar insert or shoe before the allotted time period was up.

Be sure to include the following information in your future DME claims to avoid denials as well:

• Prescription (order)
• Medical record information to support medical necessity
• Correct coding
• Proof of delivery of the DME to the patient

Standard written order: A standard written order (SWO) must be obtained by the supplier before submitting the claim. The SWO must include the following:

• Patient’s name or Medicare beneficiary identifier (MBI)
• Order date
• General description of the item
• Quantity to be dispensed, if applicable
• Treating practitioner name or national provider identifier (NPI)
• Treating practitioner’s signature

Lindsey Bush, BA, MA, CPC, Production Editor, AAPC