Thursday, February 23, 2012

Update of Medicare Modifier

"The KX modifier (Requirements specified in the medical policy have been met) is now a multipurpose informational modifier and will also be used identify services for transgender, ambiguous genitalia, and hermaphrodite beneficiaries in addition to its other existing uses. Physicians and non-physician practitioners should use modifier KX with procedure codes that are gender specific in the particular cases of transgender, ambiguous genitalia, and hermaphrodite beneficiaries. Therefore, if a gender/procedure or gender/diagnosis conflict edit occurs, the KX modifier alerts the MAC that it is not an error and will allow the claim to continue with normal processing." The modifier Code 45 is to be used by Hospitals and major medical centers.

The above modifier KX is used by doctor's office's billing departments. After gathering these changes about Medicare's billing modifiers from the NTCE, I took the copy back to my doctor's insurance person. I was amazed that she was pursuing the same questions from other billing offices around the country. It seems that someone on the West coast was able to use the billing modifiers with good results with Medicare paying for the services. We talked some more about her experiences with surgery being done in Thailand and how doctors from Britain and the US are getting additional surgicial training from the staff there. She said that she has used the same modifier when she was in Home-Healthcare to get additional services but was aware that it's use had been expanded for trans patients. She will re-submit my claims using the KX modifier.

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