Oncology & Hematology Coding Alert

Question: Which modifier should I report when a patient signs an advance beneficiary notice (ABN) for an injection of a drug, such as oxaliplatin, that Medicare might not cover? What should I do if the patient will not sign the ABN?

Alaska Subscriber  

Answer: Modifier -GA (Waiver of liability statement on file) lets Medicare know that the patient has been notified prior to receiving and accepting the service that the service may not be covered. To bill the patient appropriately, you must have an ABN on file and recorded on the claim to Medicare.

 If the patient refuses to sign the ABN and accepts or receives the treatment, you can still bill the patient if you note on the ABN that the patient was notified that the service may not be covered and refused to sign. As long as you prove that you made a valid attempt to notify the patient, youre in the clear.
 

Answers to Reader Questions and You Be the Coder were reviewed by Margaret M. Hickey, MS, MSN, RN, OCN, CORLN, an independent coding consultant based in New Orleans; and Linda L. Lively, MHA, CCS-P, RCC, CHBME, founder and CEO of American Medical Accounting and Consulting in Marietta, Ga.