Advanced Search

Anesthesia Coding Alert

Modifier Update:

Check Pump Refill Coding

Published on Thu May 13, 2004

Adding modifier -KD boosts pay for some infusion meds

If your pain management group performs lots of pump refills, it pays to double-check that you're reporting this service correctly and that your carriers are reimbursing you at the right rate.

Simply adding modifier -KD (Infusion drugs furnished through implantable durable medical equipment [DME]) to some HCPCS Codes medication codes allows you to receive 95 percent average wholesale price (AWP) for the drug instead of 85 percent AWP. This is thanks to the Medicare Prescription Drug, Improvement and Modernization Act of 2003 (DIMA), which states, "The payment limits for infusion drugs furnished through an item of implanted durable medical equipment on or after Jan. 1, 2004, are 95 percent of the Oct. 1, 2003, AWP."

Physicians incur greater expense and risk when they compound medication and place it in a pump. The updated AWP recognizes this and reimburses the practitioner more adequately for the service. Common medication codes affected by this change include:

  • J0475 -- Injection, baclofen, 10 mg. Your reimbursement increases from $192.53 to $215.18.
  • J0476 -- Injection, baclofen, 50 mcg for intrathecal trial. Reimbursement goes from $71.40 to $79.80.
  • J2271 -- Injection, morphine sulfate, 100 mg. Your reimbursement increases from $6.99 to $11.07 when you add modifier -KD.
  • J2275 -- Injection, morphine sulfate (preservative-free sterile solution), per 10 mg. Adding modifier -KD to the claim bumps your reimbursement from $1.70 per code to $4.39.
  • J7799 -- NOC drugs, other than inhalation drugs, administered through DME.

    Some carriers, such as Empire in New York and HGSAdministrators in Pennsylvania, include complete lists on their Web sites of codes you can report with modifier -KD. Check your carrier's Web site and other policy locations for more information on getting fair reimbursement with modifier -KD.

    • Other Articles in this issue of

    Anesthesia Coding Alert

    View All