What is the KX modifier for colonoscopy?
Asked by: Ethelyn Hickle III | Last update: July 1, 2025Score: 4.3/5 (23 votes)
What is KX modifier used for?
Use of the KX modifier indicates that the supplier has ensured coverage criteria for the DMEPOS billed is met and that documentation does exist to support the medical necessity of item.
What is the modifier for a colonoscopy?
For example, if a physician performing a screening colonoscopy on a patient with commercial insurance finds and removes a polyp with a snare, use CPT code 45385 and append modifier 33 to the CPT code. If the patient is a Medicare beneficiary, use CPT code 45385 with modifier PT.
When to use modifier 53 for colonoscopy?
The failed procedure is billed and paid using CPT® code 45378, HCPCS code G0105 or G0121, or CPT® code 44388, if attempting to perform the colonoscopy through an existing stoma. Modifier “-53” (discontinued procedure) must be appended to any procedure code submitted when billing for a failed colonoscopy attempt.
What is the modifier 33 for colonoscopy?
CPT® developed the 33 modifier for preventive services, for “when the primary purpose of the service is the delivery of an evidence-based service in accordance with a US Preventive Services Task Force A or B rating in effect and other preventive services identified in preventive services mandates (legislative or ...
Encore: Modifier Monday - KX Modifier
What is the KX modifier on a colonoscopy?
Modifier KX was published in Medicare's Med-Learn Matters Article, MM13017, addressing modifier KX. Medicare indicates the following: "Attach the KX modifier to a screening colonoscopy code to indicate such service was performed as a follow-up screening after a positive result from a stool-based test.”
What is the modifier 52 for colonoscopy?
Therapeutic colonoscopies that are incomplete (the scope does not reach the cecum during a therapeutic procedure) are reported with modifier 52. It is important to note that the codes for reporting these procedures differ between Medicare and other payors.
What is the 74 modifier for colonoscopy?
74 -When the colonoscopy is not documented as advanced at least into the transverse colon, append Modifier 74 (discontinued outpatient procedure after anesthesia administration). The operative report must state why and when the procedure was discontinued.
What is the 52 modifier used for?
Modifier -52 is used to indicate partial reduction or discontinuation of radiology procedures and other services that do not require anesthesia. The modifier provides a means for reporting reduced services without disturbing the identification of the basic service.
Why is a diagnostic colonoscopy not covered by insurance?
Soon after the ACA became law, some insurance companies considered a colonoscopy to no longer be just a “screening” test if a polyp was removed during the procedure. It would then be a “diagnostic” test, and would therefore be subject to co-pays and deductibles.
When to use modifier 52 vs 53?
I. Modifier -52 is used to report “reduced services.” II. Modifier -53 is used to report “discontinued procedure.” (For outpatient/ASC facility charges, see Coding Policy 39.0.)
What is the item code for colonoscopy?
Items 32222-32226 and 32228 provide for diagnostic colonoscopy when claimed alone. Where a polyp or polyps are removed during the colonoscopy, item 32229 should also be claimed in association with the appropriate colonoscopy item.
How often does Medicare pay for a colonoscopy?
Medicare covers screening colonoscopies once every 24 months if you're at high risk for colorectal cancer. If you aren't at high risk, Medicare covers the test once every 120 months, or 48 months after a previous flexible sigmoidoscopy. There's no minimum age requirement.
What is the difference between modifier KX and KS?
Use modifier KX if the beneficiary is insulin treated; or, Use modifier KS if the beneficiary is non-insulin treated.
Which of the following is an appropriate use for modifier kx?
Note: The KX modifier is used to confirm that services are medically necessary as justified by appropriate documentation in the medical record once the threshold amount has been met. There is one threshold amount for PT and SLP services combined and a separate threshold amount for OT services.
What is the 59 modifier used for?
Modifier 59 Distinct Procedural Service indicates that a procedure is separate and distinct from another procedure on the same date of service. Typically, this modifier is applied to a procedure code that is not ordinarily paid separately from the first procedure but should be paid per the specifics of the situation.
What is a 55 modifier used for?
Postoperative management only. Use this modifier to indicate that payment for the postoperative, post-discharge care is split between two or more physicians where the physicians agree on the transfer of postoperative care.
What is the 50 modifier used for?
Use modifier 50 to report bilateral procedures performed during the same operative session by the same physician in either separate operative areas (e.g., hands, feet, legs, arms, ears) or in the same operative area (e.g., nose, eyes, breasts).
How to code a colonoscopy?
What is the modifier 53 for colonoscopy?
Physicians were previously instructed to report an incomplete colonoscopy with 45378 and append modifier 53 (discontinued procedure), which is paid at the same rate as a sigmoidoscopy.
What is a 51 modifier?
Modifier 51 is defined as multiple surgeries/procedures. Multiple surgeries performed on the same day, during the same surgical session. Diagnostic Imaging Services subject to the Multiple Procedure Payment Reduction that are provided on the same day, during the same session by the same provider.
What is a 52 modifier used for?
Modifier -52 identifies that the service or procedure has been partially reduced or eliminated at the physician's discretion. The basic service described by the procedure code has been performed, but not all aspects of the service have been performed.
What is the modifier 22 for a colonoscopy?
When the colonoscopy procedure is unusual or difficult, modifier 22 (unusual procedural services) may be reported. The most specific ICD-10-CM code must be chosen and billed to its highest level of specificity. Submit this as the line diagnosis (linked to the procedure) on the claim.
What modifier is 62?
Modifier 62
Two Surgeons. The individual skills of two surgeons (each in a different specialty) are required to perform surgery on the same patient during the same operative session.