Wiki ABN's

[andersont]

Can anyone who bills dermatology help me out please? What procedures do you have Medicare patients sign an ABN?? Thanks in advance

 

[sjdurica]

Abn

An ABN is needed for anything that is a covered Medicare benefit but you have reason to believe that there is no medical necessity for the service. For example, if your provider removes skin tags it could be a covered benefit if there is a medical reason for removing them; however, if it is purely for cosmetic reasons, not medically necessary, you would need to have an ABN sign stating that it is not medically necessary and then submit to Medicare with a modifier GA to show that you have an ABN on file. Medicare will deny and then you can bill the patient.

On the other hand, if a service is never covered by Medicare, for example, a yearly preventive med physical is not a covered Medicare benefit, you are not required to have an ABN signed. You submit those services to Medicare with a modifier GY and then you can go ahead and collect from the patient.

 

[CatchTheWind]

We require them for treatment of alopecia, corns & calluses, nail debridement, and skin tags, as well as for patch testing when performed for conditions other than dermatitis, and for Unna boot application when done for any conditions other than lower extremity ulcers, varicosities, venous insufficiency, or stasis dermatitis.

If a service is never covered (such as full skin check or cosmetic services), no ABN is required, nor is it necessary to file a claim to Medicare in order to bill the patient. (The only reason you would file a claim and use the GY modifier is if you need to show a Medicare denial, such as for a secondary policy that will pay for services not covered by Medicare.)