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KX modifier - My Physician states

mariecass

Networker
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My Physician states that persistent bradycardia is the same as non-reverisible bradycardia and that it would support the KX modifier if stated as persistent. Based off the policy, I don't know that I agree with this.

Thoughts??:confused:
 

Chlrtrep

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Just an FYI NCD 20.8.3 was Delay/Put on hold my CMS memo on 9/10/2015 and determination in to be provided by your MAC. My understanding at this time is no -kx modifier is needed unless you are instructed to do so my your MAC

National Coverage for Single and Dual Chamber Pacemakers Delayed


CMS announced this week that there is a temporary delay in implementing NCD 20.8.3. All editing and decisions on coverage relative to Change Request 9078 will be made at the local Medicare Administrative Contractor (MAC) level until CMS announces a new implementation date, which they expect in the near future.

CMS issued a final decision memorandum regarding coverage of implanted permanent cardiac pacemakers, single chamber or dual chamber, and determined they are reasonable and necessary for the treatment of non-reversible symptomatic bradycardia due to sinus node dysfunction and second and/or third degree atrioventricular block on August 13, 2013, but delayed implementation until July 6, 2015.

The national coverage is now further delayed.
 

pamwayman

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Pacemaker dx question

I have a related PM question about the payable diagnoses. ( nonreversible symptomatic bradycardia due to sinus node dysfunction and second and/or third degree atrioventricular block ) Does this mean non-reversible symptomatic bradycardia due to both sinus node dysfunction and 2nd or 3rd degree heart block or just the bradycardia due to one of those?
 
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Does this mean non-reversible symptomatic bradycardia due to both sinus node dysfunction and 2nd or 3rd degree heart block or just the bradycardia due to one of those?

The answer to this is no. It means one or the other. It is confusing. Also as far as the instruction to add the KX modifier and it being delayed. This is true but we had been getting denials so we are adding.
 

DURENA

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Hi...Can anyone tell me where to locate written information regarding Medicare's delay of KX modifier for pacemakers? I read on the AAPC site that there was a memo released on 09/15/15 however I have searched the Medicare NCD and on MLN Matters and am unable to locate any memo??
Thanks
DC, CPC
 

Chlrtrep

Guest
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160
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Hi...Can anyone tell me where to locate written information regarding Medicare's delay of KX modifier for pacemakers? I read on the AAPC site that there was a memo released on 09/15/15 however I have searched the Medicare NCD and on MLN Matters and am unable to locate any memo??
Thanks
DC, CPC

This article was revised on October 28, 2015 to reflect the revised CR9078 issued on October 26. The CR was revised to direct the MACs to implement the NCD at the local level until Medicare system instructions are revised and Medicare system changes are implemented



https://www.cms.gov/Outreach-and-Education/Medicare-Learning-Network-MLN/MLNMattersArticles/downloads/MM9078.pdf
 
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Physician decisions

Ultimately as Coders we are always reminded that we didn't go to school to be a Doctor. And by the time you get a case to code, the physician has already put the implant in and made his decisions. I run into the same issue all the time, using the LCD as my Bible I ask the physician (s) where the medical necessity in the document is found. What I had to do at one point was document my communication with the Physician acknowledging that I am trusting that in his documentation somewhere in the patient records the KX modifier is justified as he was provided and is aware of the LCD. It is very difficult to get compliance and auditing to take a position when a physicians clinical judgement is on the scale. This is not new. Just recently the OIG released this on ICD's. Looking at how many systems are involved it should give a Physician caution to make sure he is documenting the bases of his clinical decisions.
http://www.justice.gov/opa/pr/nearly-500-hospitals-pay-united-states-more-250-million-resolve-false-claims-act-allegations

See this source and you see how widespread the issue becomes;https://www.healthlawyers.org/events/programs/materials/documents/fc12/504_cornish_sheeder_slides.pdf
 
Messages
626
Best answers
0
Ultimately as Coders we are always reminded that we didn't go to school to be a Doctor. And by the time you get a case to code, the physician has already put the implant in and made his decisions. I run into the same issue all the time, using the LCD as my Bible I ask the physician (s) where the medical necessity in the document is found. What I had to do at one point was document my communication with the Physician acknowledging that I am trusting that in his documentation somewhere in the patient records the KX modifier is justified as he was provided and is aware of the LCD. It is very difficult to get compliance and auditing to take a position when a physicians clinical judgement is on the scale. This is not new. Just recently the OIG released this on ICD's. Looking at how many systems are involved it should give a Physician caution to make sure he is documenting the bases of his clinical decisions.
http://www.justice.gov/opa/pr/nearly-500-hospitals-pay-united-states-more-250-million-resolve-false-claims-act-allegations

See this source and you see how widespread the issue becomes;https://www.healthlawyers.org/events/programs/materials/documents/fc12/504_cornish_sheeder_slides.pdf
This is great information thank you!
 
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