The following scenarios suggest that a patient may exceed the therapy cap and should be documented as early as the initial plan of care:. All the above indicate how the plan of care can be set up to immediately identify the likelihood of therapy exceeding the cap, it is still necessary for the therapist to weave the entire story together and address the medical necessity related to functional outcomes.
But the story needs to address the details in order to support the therapy necessary to achieve the function. Great article! Quick Question: If a provider bills on a series bill and half way through the series time period the patient crosses the cap do you apply the KX modifier to all charges on the claim or just those after the date the cap was exceeded? Hi Keith, Thanks for your question. Given that your information is only is good as of the time you verify via your MACs look-up tool , there is no harm by being a off a bit.
It is better to apply the modifier just prior to reaching the cap to save yourself having to do a clerical reopening to append the modifier if the claims was denied for being over the cap. Some MACs have issued warnings about applying the KX modifier well in advance of the patient reaching the cap. Hi Nancy, I have a question regarding the kx modifiers and who can actaully put them on the charges. I work at a facility that has outpatient pt,ot and speech as well as inpatient ltac and snf.
My question is, do the kx modifiers have to be added by the therapist who saw the patient or can a coder add those. Erica McDermott. Illustrations By: Kyle Mensch. Tags: CMS kx modifier occupational therapy physical therapy speech-language pathology therapy cap.
See More Related Posts. July 7, Common Questions from our Modifier Open Forum. Should I have my patients sign an advance beneficiary notice of noncoverage ABN just in case Medicare Government information system, CMS maintains ownership and responsibility for its computer systems.
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