Modifier KX and GA

belindapearl

Networker
Messages
48
Location
Cape Girardeau
Best answers
0
This is a DME billing question. We are having severe issues with Region D DMERC with AFO's. A lot of our claims are denying for same and similar. I understand the rationale behind the denial, but it is still aggravating. We give our patients a Cam boot (eg fracture) then as they get better we dispensed an ASO, so they are denying them. I have to appeal the carrier, they deny my appeal, then I have to submit an appeal to the C2C and they overturn the appeal. (Very long process). I was told yesterday by customer service at Region D that you can not bill KX with a GA. During a Webinar with Region D we where instructed to get ABN's when we thought they would deny for same and similar. We bill KX because the medical necessity has been met, we get an ABN to instruct the patient that if they have had the same or similar item Medicare may not pay. I still do all the appeals to get Medicare to pay, but if our patient received a Cam boot 3 years ago and did not inform us there is no winning that fight. I understand that in the perfect world you should be able to check on Dmerc's website before you dispense any item. We do check to see if we have ever dispensed the same item, but we do not have time to check DMERC's website before dispensing, thus the ABN comes into play. It was suggested that we bill with just the KX and if they deny and we do not win our appeal then re appeal stating we have the ABN. That does not make sense. Any thoughts out there?
 
Messages
2
Best answers
0
We only bill using the KX modifier, years ago we would bill with both KX & GA but like you a rep I spoke with in Jurisdiction C said we can bill with both. We have been receiving the same denials you are, are you doctors dictating the need for ASO after having the Cam boot or are you just submitting the progress notes from each visit? I am trying to see if I can have my doctor just add something in his progress notes for the need of both braces so that the appeals will be overturned.
 

belindapearl

Networker
Messages
48
Location
Cape Girardeau
Best answers
0
Yes our doctors do add the additional info. If it is a replacement for one that is lost or damaged I have the nurses do an addendum to the doctors note. This seems to be helping. I am now winning my appeals on the first try
 
Top