Wiki KX Modifier

[atraywick@ffhcia.com]

I am relatively new to Podiatry and I am trying to determine if the KX modifier is being used correctly on DME by our practice as we have had some recent recoupments. Can anyone explain when the KX should be used when billing DME?

 

[TThivierge]

Hi Atray
Sometimes we are told to use KX more documentation to follow inline with medical policy /payer. I imagine it is for supplies, shoes, socks or braces suggested for this patient. We do not use often unless payer tell us too. You might want to check with payer.But we are told to use modifier Q7-Q9 a lot with podiatry if pt. has chronic conditions plus list referral doctor if one on claim too. I hope helped you!.
Lady T

 

[podcoder70]

Medicare and Medicare Advantage plans require the KX modifier on all braces, boots, shoes etc. When you add the KX modifier to the claim, you are telling the payer that you have all the documents required to dispense. It also tells them that you have met medical necessity. Some of these items have very specific documentation requirements, such as DM shoes/inserts and AFOs. If you have been getting recoups from these Medicare plans, it could be due to the same/similar issues...they got something similar in the last 5 years. Q modifiers are not to be used for DME and KX modifiers are not to be used with supplies such as dressings.

 

[Pam Blackford]

Refer to the LCD on the code, then you need to read the article that goes with the LCD. it will tell you what the guidelines are for the DME codes. If you are following the guidelines then you can use the KX modifier. An example of when you can't add it is if you are doing custom orthotics (L3000) and they are not being used as an integral part of a brace. If you add the KX then they can be paid. But you should only add it if you are using them as part of a brace. So they aren't payable if not, and the KX can't be used. You have to read the LCD AND the article. Very important.