EM Coding Alert

Question: What are the G modifiers we may use on our services that need ABN claims?

Georgia Subscriber

Answer: You should obtain an advance beneficiary notice (ABN) to keep compliant if you are unsure about whether Medicare will cover a patient's E/M service.

Once you've provided the patient with an appropriately issued ABN, Medicare also asks you to append the proper G modifier. Although the G modifiers are not required to garner payment for the services, experts agree it's a good idea to use the modifiers for compliance reasons. Additionally, the G modifiers also make things easier on the payers and the patients, as they indicate whether you will be able to request payment from the patient.

Here is a list of the G modifiers you might use on your ABN claims.

• GA (Waiver of liability statement issued as required by payer policy, individual case)
• GX (Notice of liability issued, voluntary under payer policy)
• GY (Item or service statutorily excluded, does not meet the definition of any Medicare benefit or, for non-Medicare insurers, is not a contract benefit)
• GZ (Item or service expected to be denied as not reasonable and necessary).