Medicare uses G modifiers to specify why practice issues ABN.
Patients that report to your physician for evaluation and management (E/M) services that Medicare might not completely cover should always be on your Advance Beneficiary Notice (ABN) radar.
Once you’ve provided the patient with the ABN, Medicare also asks that you append the proper G modifier. While the G modifiers are not required to garner pay for the services, experts think it’s a good idea to use the modifiers for compliance reasons. G modifiers also make things easier on payers, as they indicate whether you will be able to request payment from the patient.
Check out this rundown of the G modifiers you might use on your ABN claims.
Mark Mandatory ABN Issuance With GA
Here’s a list of the G modifiers you’ll choose from for ABN services, along with some analysis from Steven M. Verno, CMBSI, CHCSI, CMSCS, CEMCS, CPM-MCS, CHM, SSDD, a coding, billing, and practice management consultant in central Florida:
Use G Modifiers to Stay in Coding ‘Mainstream’
While the G modifiers won’t impact Medicare’s payment for the service, it might use the information to look into billing patterns at your practice, explains Leslie Johnson, CPC, CSFAC, chief coding officer at PRN Advisors in Palm Coast, Fla.
Explanation: Medicare tracks every single code and modifier that you report. “Codes that are reported — or not reported — are indicative of patterns that are tracked by the data-mining systems. Deviate from the norm one way or another, and this could attract unwanted attention” from Medicare, Johnson warns.
Best bet: Reduce the risk of being a coding outlier by submitting G modifiers whenever you report a service for which you have an ABN on file.