Ophthalmology and Optometry Coding Alert

Question: Are patients undergoing keratoconus workup or contact lens fitting still required to sign an advance beneficiary notice (ABN)? Why is it necessary when Medicare won't pay for it anyway?Nebraska SubscriberAnswer: According to CMS, the ABN is necessary "for the physician to bill a Medicare beneficiary for services which are always denied for medical necessity (e.g., visual fields for a patient without a covered diagnosis), frequency limited items (repeat of visual fields or other test more frequently than covered by the carrier or contractor), denial of advanced determination of Medicare coverage (ADMC), and certain instances of upgrades.The ABN is voluntary for items that are statutorily excluded (never covered by Medicare, such as refraction) or do not meet the definition of a Medicare benefit.A patient undergoing a keratonocus workup or contact lens fitting needs to sign an ABN from Medicare informing him that he is responsible for the payment, although it [...]