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Oncology & Hematology Coding Alert

Reader Questions:

Modifier KX on PET Claims Explained

Published on Mon Feb 07, 2011

Question: We bill the global service for NaF-18 PET scans for bone mets. Are we supposed to add modifier KX to these claims for Medicare?Answer: No. Because you're reporting the global service, Medicare does not require you to append modifier KX (Requirements specified in the medical policy have been met).Download this: In Transmittal 2096, CR 7125 (www.cms.gov/transmittals/downloads/R2096CP.pdf), CMS published the guidelines on coding these services (including a helpful chart showing which tracer codes pair with which PET codes).TC/Global: When you report a global or technical only claim with A9580 (Sodium fluoride f-18, diagnostic, per study dose, up to 30 millicuries) and an NaF-18 PET service "to inform the initial treatment strategy or subsequent treatment strategy for bone metastasis," the transmittal instructs carriers to process claims that include ALL of the following (in addition to A9580):One of these modifiers:PI (Positron emission tomography [PET] or PET/ computed tomography [CT] to inform [...]
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