ASGE members may submit coding inquiries electronically to codingquestions@asge.org. When submitting a question, please allow at least three business days for a response. When submitting inquiries, please include the ASGE member’s name and ID number. Only questions will be accepted and not reports. Below is our featured Coding Question of the Month that could be beneficial to your practice.
Question
We are a little confused regarding Modifier KX. Should this modifier be used for only a screening after a positive Cologuard, no biopsies ex: Z12.11/R19.5 G0121/KX, biopsy/polyp removed Z12.11/D12.0/R19.5 45385/KX/PT or both scenarios?
Also, if a patient has a personal history of polyps and had a positive Cologuard, can we bill Z12.11/Z86.0101/R19.5 45385/D12.0/KX/PT? I was informed this applies to all Medicare Advantage plans. Is that correct?
Answer
When MCR published the use of Modifier KX, they only gave examples for the G0121 and not the surgical codes. I don't think it's "wrong" to add it; however, I would list PT in the first position since this PT affects payment and how the claim is processed.
It does not make sense for the patient to have a Cologuard if they have a personal history of colon polyps. Per CMS, Cologuard only applies to patients with average risk without any personal or family history.