Ophthalmology and Optometry Coding Alert

Time is running out: The three-month grace period for implementing modifier -KX (Specific required documentation on file), a new HCPCS modifier effective July 1, 2002, ended Oct. 1. This means coders can no longer get away with employing the outdated -ZX modifier on durable medical equipment claims.

Here's the scoop: The -ZX modifier used by many durable medical equipment carriers (DMERCs) to indicate "specific required documentation on file" has been discontinued and replaced with -KX  the new HCPCS level II national modifier. And beginning in October, claims will be rejected or denied for an invalid modifier if -ZX is used instead of -KX.

An example of when -KX should be used is for tints (V2740-V2744), anti-reflective coating (V2750), or oversized lenses (V2780) that are specifically ordered by a treating physician, according to Cigna Medicare Region D's refractive lens local medical review policy. "When the -KX modifier is billed, documentation to support the medical necessity of the lens feature must be available to the DMERC on request." However, modifier -KX should not be used with these same codes if they are ordered as a patient preference item.