Tips to Avoid Denials of Claims

Although there are procedures that are specific to gender, you can avoid unnecessary denials of claims when the patient’s gender of record or diagnosis and procedure do not match.

• The use of condition code 45 will allow diagnosis to procedure conflicts to bypass being denied.
• Modifier KX can be appended to a claim line to indicate that even though a procedure is gender-specific, it’s appropriate to that patient.

Although Quartz does not require the use of these at this time, we encourage using the condition code or modifier when submitting claims for members with ambiguous genitalia or who are transgender. This will provide a better, more efficient member experience.