Wiki ABN's question

[Justarose]

Patient has signed the ABN ...we are using the GX

Can anyone clarify my understanding before we file and lose everything -

If I apply the GX to the specific drug codes ; we know they are not going to pay ... but what about the ADMINISTRATION codes ? Will they pay those ...or do I have to include them with the non-covered charges ?

Also : there are a lot other drugs used that are not a part of the ABN - am I to bill them on a seperate claim so that Medicare does not deny them all ??

If I am reading their MLN correct it seems if I file the whole claim with all charges and apply the GX to even ONE line they will NOT pay the entire claim ...

Please clarify ...
Thank you !!!

 

[LLovett]

Ok, these are non-covered services that you are giving and elective ABN correct? So you would have used the GY previously or nothing at all.

My understanding is if you incorrectly put a GX on an item they would pay for they will kick the whole claim out. As long as you use it correctly they will process all items on the claim leaving anything with the GX as patient liability.

"Medicare systems will recognize and allow the –GX modifier on claims, but will return the claim if the –GX modifier is used on any line reporting covered charges."

http://www.cms.hhs.gov/ContractorLearningResources/downloads/JA6563.pdf

This doesn't go into effect until April 1, 2010.

Laura, CPC, CEMC