Advanced Search

Primary Care Coding Alert

Reader Question:

Pull Out ABN for Benign Lesion Excisions

Published on Mon Aug 06, 2012

Question: Our state Medicaid doesn't cover benign lesion excisions, but we don't know it's benign until the pathology report comes back. Are we supposed to not remove suspicious lesions? Or are we supposed to remove them but not get paid? Oregon Subscriber Answer: Your first step is to have the patient sign an Advance Beneficiary Notice (or similar form that is satisfactory under your state's Medicaid program) accepting financial responsibility if Medicaid (or another insurance company) doesn't pay for the service. Explain that you will file the claim because of protocol, but that you expect it to be denied, if the lesion is determined to be benign. Give the patient an estimate of what her expense might be, if possible. You may want to take a similar approach if the removal is for cosmetic reasons.
You’ve reached your limit of free articles. Already a subscriber? Log in.
Not a subscriber? Subscribe today to continue reading this article. Plus, you’ll get:
  • Simple explanations of current healthcare regulations and payer programs
  • Real-world reporting scenarios solved by our expert coders
  • Industry news, such as MAC and RAC activities, the OIG Work Plan, and CERT reports
  • Instant access to every article ever published in your eNewsletter
  • 6 annual AAPC-approved CEUs*
  • The latest updates for CPT®, ICD-10-CM, HCPCS Level II, NCCI edits, modifiers, compliance, technology, practice management, and more
*CEUs available with select eNewsletters.

Other Articles in this issue of

Primary Care Coding Alert

View All