Pathology/Lab Coding Alert

All new GX and revised GA clarify liability statement. Ever since CMS rolled the Notice of Exclusion of Medicare Benefits (NEMB) into the Advance Beneficiary Notice of Non-Coverage (ABN), labs have had trouble sorting out optional versus mandatory patient notification. Here's help: Read on to determine when you may and when you must file an ABN, and how modifiers can help you identify the difference. Zero In on Mandatory ABNs "ABNs are mandatory when the provider believes that Medicare may not determine the service to be 'reasonable and medically necessary,'" says Genevieve Tang, reimbursement consultant at Quorum Consulting, a healthcare consulting company in San Francisco. That means you would need to have an ABN on file in the following circumstances, according to Tang: The test exceeds the local Medicare contractor's utilization frequency limits The Medicare contractor has a Local Coverage Determination (LCD) or article that explicitly establishes noncoverage for the [...]