Wiki Specimen Reading after Patient Death

[alwaysunny84]

According to CMS guidelines we bill with for a date of service that the specimen is read and signed by the pathologist.
I have a specimen that was looked at the day following the death of a patient. CMS is telling me there is a HCPCS modifier specific
to this situation but I have not been able to find it. Post mortem (PM) doesn't work, one is specific to ambulance billing etc. I have read and
reread the lists but I'm clearly overlooking something. Does anyone have any experience with this?

Thank you!

Diane

 

[RobynKing]

I too was told about this but I have not been able to find a modifier that properly denotes this subject. I would be interested in finding out what this modifier would be.

 

[cgaston]

I found two modifiers that could work:

CA

Procedure payable only in the inpatient setting when performed emergently on an outpatient who expires prior to admission.

Centers for Medicare & Medicaid Services (CMS) Internet Only Manual (IOM), Publication 100-04, Medicare Claims Processing Manual Chapter 4 - Part B Hospital (Including Inpatient Hospital Part B and OPPS) Section 180.7

KX

Requirements specified in the Medical Policy have been met

I guess the CA would work if the visit meets the "inpatient-only service performed emergently on an out patient who expired prior to admission" but I would lean towards the KX myself.

The KX is used when you know that the information on the claim does not make sense (like billing for a service after the patient expired or for transgender people receiving a service on anatomy that does not "match" their documented gender) and the modifier lets them know that you have supporting documentation to explain the discrepancy.