tci General Surgery Coding Alert - 2010 Issue 16

READER QUESTIONS : Learn New Use for KX Modifier

Question: I've heard that Medicare has a new way to override gender-specific edits, when appropriate, based on patient circumstances. Are we supposed to use a specific  modifier? Arizona Subscriber Answer: You'll use new condition code 45 (Ambiguous gender category) with claims that may be denied "due to sex/diagnosis and sex/procedure edits," according to MLN Matters article MM6638. You'll use this code when "the service performed is gender specific (i.e., services that are considered female or male only)," the article notes. "This claim level condition code should be used by providers to identify these unique claims and...

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