Clinical Documentation: Connecting the Dots | Join Webinar & Earn 1 AAPC® CEURegister Now >>

Part B Insider (Multispecialty) Coding Alert

Part B Coding Coach:

Coding Quiz--How Much Do Your Really Know About ABNs?

Demystify modifiers GA, GY and GZ

You use advance beneficiary notices (ABNs) to let beneficiaries know of services that Medicare may not cover. But if you think ABNs are a piece of cake, you might be in for a surprise. Take this three-question quiz to see whether you can determine how to use ABNs. Patient Didn't Understand ABN Question 1: We have a patient with generalized hyperhidrosis (780.8) who signed an ABN for Botulinum administration, and, as we suspected, her Medicare carrier won't pay for the services. Now the patient is saying that she didn't understand what the ABN meant and she is refusing to pay. What should I doin this situation?

Answer 1: The patient is responsible, says Heather Corcoran, coding manager at CGH Billing Services in Louisville, Ky. An ABN is a written notice a provider gives a Medicare beneficiary before furnishing items or services when the provider believes that Medicare will not pay on the basis of medical reasonableness or medical necessity. Remember these additional factors:

Making informed decisions: You-ve already put the patient on notice that Medicare coverage is unlikely. With this information, the patient is then in a better position as a healthcare consumer to make an informed decision about which services he may have to pay for out of pocket or through other insurance.

Mistake: When issuing an ABN, you must advise the Medicare beneficiary that he will be personally and fully responsible for payment of all items and services specified on the ABN if Medicare denies the claim.

Be aware that Medicare considers an ABN improperly issued under the following circumstances:

- When the provider refuses to answer inquiries from a patient or the patient's authorized representative.

- When a practice uses an ABN to shift liability to the beneficiary for items/services when full payment for those items/services is already bundled into other payments.
Your failure to provide a proper ABN when one is required may result in your provider being found liable. In most situations, however, you should simply remind the patient that he agreed to have the services provided and signed the ABN. And you should point out that you explained at that time that he must pay if Medicare doesn't cover the services. Suggest that the patient contact Medicare if he has further questions. ABN or NEMB? Question 2: If I provide a service that I know Medicare won't cover (such as personal comfort items, orthotics, preventive medicine/routine physical exams/cosmetic surgery), am I required to offer the patient a notice of exclusion from Medicare benefits (NEMB)?


Other Articles in this issue of

Part B Insider (Multispecialty) Coding Alert

View All