I code for the facility not the professional services.
I am being asked to review a claim that denied due to Pt has meet max benefits for the year. The AR rep is stating they were advised that this case scenario may meet the requirements to add the KX modifier. When would it be appropriate to add this MOD in an ASC setting? In my personal experience I have only seen this used for therapy services such as PT and OT. In this particular case in question the patient had a Phacoemulsification with a intraocular lens prosthesis that was placed on one eye and two weeks later came back for the other side. The CPT code used was 66984. Any advice or reference material you can point me in the direction to would be great. Thank you in advanced.
I am being asked to review a claim that denied due to Pt has meet max benefits for the year. The AR rep is stating they were advised that this case scenario may meet the requirements to add the KX modifier. When would it be appropriate to add this MOD in an ASC setting? In my personal experience I have only seen this used for therapy services such as PT and OT. In this particular case in question the patient had a Phacoemulsification with a intraocular lens prosthesis that was placed on one eye and two weeks later came back for the other side. The CPT code used was 66984. Any advice or reference material you can point me in the direction to would be great. Thank you in advanced.
