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ABN modifiers

Maarit Posted Mon 11th of April, 2011 18:50:37 PM

I need advice for when to use modifiers GA or GX. I code for a plastics clinic where we often remove skin tags (11200) and destroy benign skin lesions (17110). an ABN is signed routinely for these. However, it is my understanding that if the documentation supports medical necessity for the removal/ destruction (for example: pain, extreme itching, inflammation..etc) an ABN is not necessary. Is this correct? Also, is it true that, if GA or GX is used, to indicate that an ABN was signed, Medicare will automatically deny payment and make the balance PT responsibility? Can you give me an example for when GX is used? Are any clinics using these modifiers on claims to private payers like Premera Blue Cross and LifeWise Health Plan of Washington? Thank you for your assistance. ag

SuperCoder Answered Mon 11th of April, 2011 20:18:42 PM

GX modifier reads "notice of liability issued, voluntary under policy." Use this modifier when you know that a specific service is considered non-covered by Medicare. Since the service is non-covered you technically do not have to give an ABN to a patient to sign, hence "voluntary", but it is a good idea to inform the patient that they are financially responsible. Plus you may still want to bill Medicare to get the denial to forward to the secondary payer.

Regarding Reimbursement of 11200 and 17100, if you are facing denials, then plz don't go by just ICD crosswalks. Plz go by LCD parameters. It's totally different.

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