Pathology/Lab Coding Alert

Plus GX is back for patient responsibility.When your Medicare payer processes a denial quickly, that's usually bad news for your lab. But modifier GZ (Item or service expected to be denied as not reasonable and necessary) means you're already expecting a denial, so a speedy resolution actually helps by taking the claim off your lab's to-do list. CMS will make the denials happen even faster with a new policy to immediately deny all services with modifier GZ appended beginning July 1.How Modifier GZ WorksIf you're still wondering why anyone would want a quick denial, here's a closer look at how modifier GZ works. If the lab performs a service you expect Medicare to find medically unnecessary based on the agency's rules, and there's no Advance Beneficiary Notice (ABN) on file, you should append modifier GZ to the CPT® code for the service. The advantage of reporting modifier GZ is avoiding [...]