tci General Surgery Coding Alert - 2014 Issue 10

Reader Question: Bring In ABN Benefits

Question: Should I bill Medicare for services that I know they’ll deny based on coverage rules for medical necessity, such as a screening colonoscopy within the frequency limits? Texas Subscriber Answer: If you expect Medicare to deny a claim based on lack of medical necessity under coverage rules, you should inform the patient and have him sign an advance beneficiary notice (ABN). When you bill Medicare, you should append modifier GA (Waiver of liability statement issued as required by payer policy, individual case) to the procedure code.  Using this modifier indicates to Medicare that you anticipate a...

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