Reminder: Modifier KX is the cure for gender-based denials

by: Julia Kyles, CPC Jun 8, 2023

Practices that treat transgender, intersex, and gender-expansive patients take note: When a gender-specific procedure or diagnosis code doesn’t match the patient’s reported sex, coders should append modifier KX (Requirements specified in the medical policy have been met) to the claim.

CMS released the policy in 2009 to remedy inappropriate gender-based denials and issued a reminder today.

“For any procedure codes often considered appropriate for only one gender, indicate on the claim detail line if the patient’s experienced gender is different than their sex at birth,” according to the June 8 MLN Connects Newsletter.

Modifier KX will override gender/procedure and gender/diagnosis conflict edits for Part B claims and tell the Medicare administrative contractor to process the claim, according to the original policy CMS published in CMS 100-04, Change Request 6638.

The update also tells Part A coders that effective July 1, the National Uniform Billing Committee will revise Condition Code 45 from “Ambiguous Gender Category” to “Gender Incongruence.” They should continue to use the condition code when appropriate.

Blog Tags: claims processing, CMS

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