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Hcpcs and modifiers

  1. Default Hcpcs and modifiers
    Medical Coding Books
    Hello everyone, I have a question if anyone can help me. I am new to the orthopedics coding and I took over someones place, and she always coded a L4386 code with the following modifiers KX, GX, LT. I am not understanding why she added these. Any input would be nice. These claims are going to Noridian.

    Thanks,

    Krystal Prass,CPC-A
    Krystal Prass, CPC-A

  2. #2
    Location
    Tacoma, WA
    Posts
    1,087
    Default
    Quote Originally Posted by krystalcamren@yahoo.com View Post
    Hello everyone, I have a question if anyone can help me. I am new to the orthopedics coding and I took over someones place, and she always coded a L4386 code with the following modifiers KX, GX, LT. I am not understanding why she added these. Any input would be nice. These claims are going to Noridian.

    Thanks,

    Krystal Prass,CPC-A
    Ok, this is for a walking boot that is considered DME supply item. If it is provided in the office it is not covered by Medicare unless you have the ability to bill your local DME carrier,(most physician office don't). Since it is Medicare and non-covered, the modifiers indicate: LT - left side, GX - non-covered item or service and the patient has been informed and agrees to pay, and KX - you have met all the requirements to bill this item to the patient.

    It will be denied by Noridian, but will show that you are allowed to collect from the patient.
    Arlene J. Smith, CPC, CPMA, CEMC, COBGC

  3. #3
    Location
    Columbia, MO
    Posts
    12,843
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    To use the GX you must have signed voluntary ABN in the medical record, signed by the patient.

    Debra A. Mitchell, MSPH, CPC-H

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