Nondiscrimination Coding Requirements
Issue: #392 JAN2017
Effective January 1, 2017, in order to assist in identifying services that are gender specific that may not process correctly for transgender individuals, providers should identify gender-specific (i.e., services that are considered female or male only) services for transgender individuals with the KX modifier on professional claims and Condition Code 45 for institutional claims. This will support compliance with the federal nondiscrimination requirements for transgender individuals.
The KX modifier, which is defined as “Requirements specified in the medical policy have been met,” is a multipurpose informational modifier. In addition to its other existing uses, the KX modifier should also be used to identify services that are gender specific for affected members. Use of the KX modifier with a gender-identity diagnosis will alert Blue Cross Blue Shield of North Dakota (BCBSND) that the physician/practitioner is performing a service on a patient for whom gender-specific editing may apply and that the service should be allowed to continue with normal processing. Payment will be made if the coverage and reporting criteria have been met for the service.
The National Uniform Billing Committee approved Condition Code 45 (Ambiguous Gender Category) to identify institutional claims that may be denied due to sex/diagnosis and sex/procedure edits. Use of the condition code on institutional claims will allow the service to continue through normal processing.
BCBSND recognizes that transgender individuals may have a difficult time navigating through the health care system and would like to assist these individuals through our Case Management Program. Providers working with these members can contact Case Management at 1-800-336-2488 for assistance.