Modifier KX - documentation on file

Lisa Bledsoe

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Can someone please explain this modifier to me? Our Medicare carrier is telling us to put it on all of our DME's, but I don't completely understand the definition "documentation on file" or how it pertains the therapy caps, etc. HELP!!:eek:
 

k5coate

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After you have hit the therapy cap you will want to use the kx modifier. If you don't use the kx modifier your claim will be denied.
 

Lisa Bledsoe

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What does that have to do with orthotics or urology supplies provided in the office setting? We are told to use kx to get these items paid, but I don't think that adding that modifier just to get something paid is appropriate...
 

Anna Weaver

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kx rationale

Using the KX modifier indicates that the Dr. has written this order, it was used to order the equipment/drugs/supplies needed to treat the patient. These orders are usually good for a limited time period. Usually 1 year (in the case of medications/supplies for diabetes). This order must be kept on file by the supplier and made available to the carrier on request. That's what it means by required documentation on file. This should indicate the diagnosis/reason for the equipment/medication and the date, the Dr. signature etc. as with any other order. All the "stuff" must be there, on file, and accessible.
This is my understanding of the KX modifier. If this is incorrect can someone please let me know?
 

avassell

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KX Modifier related to Toxins ie botox for dystonia etc.

Along the same lines of the KX modifer - does it get appended to each cpt code billed or just the toxin- J codes only?

Thanks !
 

courtcadle

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KX is used on I'd say 85% of DME items. Meaning the patient meets the medical criteria Medicare has in their medical policies. KX means something different depending on what the HCPC is, for the criteria is different. If the patient doesn't meet the criteria per that policy then GA or GZ must be used (this will result in a denial) which may or not be billed to the patient, depending on which you use. KX is the only way to get paid for these items, but you should only be putting it if the patient meets the criteria & you are able to prove that they do.

Medical policies can be found here:
http://www.cms.gov/mcd/results_inde...rvices, Inc. (17003, DME MAC)&letter_range=4&
 
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