Are you with Trailblazers? If so, you now have to bill with a KX modifier on the admin code. i'll post the notice below.
Through the medical review of various infusion drugs, TrailBlazer identified two problems:
â€¢Billing incorrect quantities of the drug administered.
â€¢Billing chemotherapy administration codes inappropriately.
As a result of these findings, the Medical Review department implemented audits to suspend claims for specific drugs to determine if the quantity and administration codes are billed correctly. While reviewing these claims, TrailBlazer has also found that in some cases administration codes are billed without a corresponding drug on the same date of service.
Drug administration billed without a corresponding drug will result in a denial of the administration code. An example seen during the review was patients purchasing a drug and bringing it to the physicianâ€™s office for the drug to be administered by the physicianâ€™s staff. In this situation, the physician should:
â€¢Bill the HCPCS code for the drug administered with the correct quantity (according to the dose per unit specified in HCPCS) and a zero charge.
â€¢Append the KX modifier to the administration code.
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