Wiki Modifer KQ

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dlpirtle

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The oncology practice I work for is in Illinois. We billed a patients Medicaid for the chemotherapy treatment they received. We received a denial and when we called Medicaid, they stated that instead of the 76 modifier, we would need to use the KQ modifier for the chemotherapy. This chemotherapy is a combination of two drugs with one "J" code and NDC for the vial size used. There were 2 vial sizes used so 2 different NDC's but I do not think that we should use the KQ modifier for this. Am I thinking right in this instance?
Thank you.
 
I think they are correct. The description of modifier 76 indicates a repeated procedure. A drug is not a procedure, so using this modifier on a drug code would be an error. Modifier KQ - Second or subsequent drug of a multiple drug unit dose formulation - is more specific and more accurately describes what you are reporting. And the payer is also telling you that this is what you need to do. What is your rationale for thinking you shouldn't use this modifier?

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With Illinois Medicaid, we bill using NDC codes and the J code. The drug in question is Rituxan Hycela (J9311). It is Rituximab and Hyaluronidase human, 2 drugs in the same single dose vial with the same "J" code and same NDC #. Medicaid stated that we needed to use the KQ modifier. Since both drugs are mixed in the same vial, I do not see how we can use the KQ modifier on the charge for the Hycela. If we gave the patient Rituxan (J9312) which comes in a 500mg SDV and 100mg SDV, we would bill those on separate lines. I would think that the KQ would work more for say Zofran (J2405) and Dexamethasone (J1100) which can be mixed together in the same bag. What do you think?
 
dlpirtle said:
With Illinois Medicaid, we bill using NDC codes and the J code. The drug in question is Rituxan Hycela (J9311). It is Rituximab and Hyaluronidase human, 2 drugs in the same single dose vial with the same "J" code and same NDC #. Medicaid stated that we needed to use the KQ modifier. Since both drugs are mixed in the same vial, I do not see how we can use the KQ modifier on the charge for the Hycela. If we gave the patient Rituxan (J9312) which comes in a 500mg SDV and 100mg SDV, we would bill those on separate lines. I would think that the KQ would work more for say Zofran (J2405) and Dexamethasone (J1100) which can be mixed together in the same bag. What do you think?
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I see what you are saying, but I guess it depends on how someone interprets the language in the description of the modifier. Technically speaking, you are billing a second drug since you're billing a different NDC number, even though it's the same two drugs that are compounded.

In any case, I don't think you have many alternatives here and I don't know of a better solution. You can't use 76 since they denied it, and I'm pretty sure that they'd also deny it if you tried one of the other procedural modifiers such as 59, XU, etc. If you really want to, you could try billing it without any modifier, but it could then deny as a duplicate. Then you could appeal it with a letter explaining why it's not a duplicate. But if they've already told you to use KQ, then why go through all that? The NDCs you are attached will clearly report the specifics of the drugs you're billing for, so you're being completely transparent with your payer I don't think there's any concerns here about potential fraud or abuse on the HCPCS or modifier coding.
 
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