Wiki Facet/MBB new guidelines KX mod

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Hello, Did you figure this out? I am confused about when to use the KX modifier as well. Also, am I understanding the LCD correctly that code 64495 will be covered only upon appeal and with sufficient medical records supporting medical necessity?
 
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I did attend a CMS webinar , the 1st 2 Diagnostic injections will apply the KX modifier , not 100 % sure is on all lines or just the 1st code depending on levels. If the patient does not reach the required 80% improvement & 50 % relief if a 3rd Diagnostic is required that too will apply KX to . Yes, if the 64492 or 64495 is billed these will deny and an appeal will be required with supporting documentation . Still a little confusing . If you would give me you email I can forward you the Q & As from the webinar if you like . Its still a bit confusing
 
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DGgirll20 said:
I did attend a CMS webinar , the 1st 2 Diagnostic injections will apply the KX modifier , not 100 % sure is on all lines or just the 1st code depending on levels. If the patient does not reach the required 80% improvement & 50 % relief if a 3rd Diagnostic is required that too will apply KX to . Yes, if the 64492 or 64495 is billed these will deny and an appeal will be required with supporting documentation . Still a little confusing . If you would give me you email I can forward you the Q & As from the webinar if you like . Its still a bit confusing
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DGgirll20 - Thank you for the info on the 64492 & 64495 denials! I will take any and all help/info you can give me (sarthur@bluearrowmedical.com). I am having trouble getting mine paid at all - they are denying for medical necessity and I hate how First Coast Service Options has done away with providing the allowed dx list like they used to so I could give providers some sort of helpful guidance.
 
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I'm sure you're aware that the 6449- codes are the same for therapeutic facet joint injections and medial branch blocks as precursor to RFA. So I think they're using the KX to differentiate which procedure you're doing (because you wouldn't do the facet inj as frequently as you would the mbb). I am annoyed though that they are automatically denying the third levels, I don't want to appeal every single time so my providers are going to just do two per visit (we usually do three), and maybe some trigger points in the area as well if needed.

Denials for medical necessity usually mean your diagnoses don't match up - most of the time my providers use M47.89- for spondylosis. You can click here to view the diagnoses that support medical necessity!
 
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