Podiatry Coding & Billing Alert

Procedure codes that allow modifier KX include 27600 and 64905.

The Medicare Administrative Contractor (MAC) WPS recently changed its stance on modifier KX (Requirements specified in the medical policy have been met) on certain procedure codes for podiatrists. Not only do you need to know which codes now allow modifier KX, but you should also understand the appropriate use of this modifier.

Read on to learn what changed.

You Can Now Append Modifier KX to These Procedure Codes

WPS’ recent change allows the KX modifier on certain procedure codes for podiatrists, per their recent YouTube video “Podiatrist’s Use of KX Modifier.”

“Our contractor medical directors [CMD] reviewed the state scope of podiatrists and determined some procedure codes can be paid when billed with the KX modifier for services on or after August 30, 2021,” according to the video.

The current procedure codes that allow modifier KX are as follows:

• 27600 (Decompression fasciotomy, leg; anterior and/or lateral compartments only)
• 64575 (Incision for implantation of neurostimulator electrode array; peripheral nerve (excludes sacral nerve)) and 64580 (… neuromuscular)
• 64585 (Revision or removal of peripheral neurostimulator electrode array)
• 64708 (Neuroplasty, major peripheral nerve, arm or leg, open; other than specified)
• 64890 (Nerve graft (includes obtaining graft), single strand, hand or foot; up to 4 cm length)-64892 (Nerve graft (includes obtaining graft), single strand, arm or leg; up to 4 cm length)
• 64905 (Nerve pedicle transfer; first stage)
• 64910 (Nerve repair; with synthetic conduit or vein allograft (eg, nerve tube), each nerve)
• 64912 (Nerve repair; with nerve allograft, each nerve, first strand (cable)) and +64913 (Nerve repair; with nerve allograft, each additional strand (List separately in addition to code for primary procedure))

“Our Medical Policy staff will continue to review services that may fall within the scope of practice for podiatrists,” according to a recent WPS press release. “They may add additional codes to the list of payable services in the future.”

Make Sure You Meet Certain Requirements for KX Modifier

By using the KX modifier, your podiatrist is attesting that he meets certain requirements to bill for the procedure, WPS says. These requirements are as follows:

1. Your podiatrist’s state license allows them to perform the procedure.

2. Your podiatrist has the required training and can provide documentation proving they completed the training upon request.

3. When you append modifier KX to a claim, you are stating that your claim has met the specific documentation requirements set forth in the policy.

4. You can provide additional documentation to support the medical necessity of an item or service under a medical policy.

Don’t forget: It’s your podiatrist’s responsibility to prove that their state license allows him to perform these procedures and prove that they are trained to do so.

Don’t Use Modifier KX Under These Circumstances

On the other hand, under certain circumstances, it would be considered inappropriate to use modifier KX. These situations are as follows:

• When the service denial is statutorily required;
• When the claim form provides all the information on the billed service and the medical documentation does not provide further explanation; and
• When the claim does not meet policy guidelines, indications and limitations of coverage, and/or medical necessity.