Wiki Modifier needed for injection?

[kjdallas]

We have several patients who bring their own medication. Do I need to append a modifier to the administration or to the HCPC code (with a zero amount)?
Thanks!

 

[mhstrauss]

You shouldn't need a modifier on the admin code for the injection. We have similar situations for Botox, 1 carrier requires us to order through a specialty pharm instead of using our supply; for those patients we only bill the injection code, and EMG if used. We do enter the J code in our system with "0" charge, but it doesn't go on the claim, it's only for tracking purposes. Same thing when samples are used--we only bill out the injection code.

Hope that answered your question!

 

[kjdallas]

Thanks, that's what I've been doing, but we got a denial that (surprise) made no sense, so I was trying to figure out what they wanted.

 

[cycmkdill]

Per the Medicare guidelines, you would need to append the KX modifier to the administration for the drug with a zero charge.

 

[mhstrauss]

I wasn't aware of that guideline...this isn't a problem in our clinic, but I did just find an early thread about the KX modifier being required; here's the link:

https://www.aapc.com/memberarea/forums/showthread.php?t=47085

and will definitely be researching this more!