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??
This is great information thank you!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.
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