VFarrell
Guest
Should we use a different modifier than GA to indicate an ABN has been signed?
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Wiki GA modifier
- Thread starter VFarrell
- Start date
SharonCollachi
Guest
These are my notes, but I haven't updated them in a very long time, because we rarely provide a service that requires an ABN. I believe they are still correct.
GX: used to show that you are providing a service that is never covered, and you DID get an ABN.
GY: used to show that you are providing a service that is never covered, and you DID NOT get an ABN.
GA: used to show you expect that Medicare will deny a service as not reasonable and necessary, and you DID get an ABN.
GZ: used to show you expect that Medicare will deny a service as not reasonable and necessary, and you DID NOT get an ABN.
I recommend never getting yourself into a GY situation. There is no reason to provide a service that you know is not covered and NOT have the patient sign the ABN. It's a CYA situation - the patient is acknowledging Medicare never covers the service, and that they are financially responsible for it. Otherwise, all they have to do is call Medicare and complain that you did not tell them they would have to pay for it, blah blah blah. Just don't go there.
GX: used to show that you are providing a service that is never covered, and you DID get an ABN.
GY: used to show that you are providing a service that is never covered, and you DID NOT get an ABN.
GA: used to show you expect that Medicare will deny a service as not reasonable and necessary, and you DID get an ABN.
GZ: used to show you expect that Medicare will deny a service as not reasonable and necessary, and you DID NOT get an ABN.
I recommend never getting yourself into a GY situation. There is no reason to provide a service that you know is not covered and NOT have the patient sign the ABN. It's a CYA situation - the patient is acknowledging Medicare never covers the service, and that they are financially responsible for it. Otherwise, all they have to do is call Medicare and complain that you did not tell them they would have to pay for it, blah blah blah. Just don't go there.
VFarrell
Guest
Perfect, thank you.
I guess my question really revolves around whether or not a modifier is required if a "service" is provided and it is normally covered by Medicare.
Is a modifier required to indicate a ABN is signed?
I have one person who has always added a GA modifier, but recently had denials on it.
I have another person that never puts a modifier on a approved service even when ABN signed.
Which is correct?
I guess my question really revolves around whether or not a modifier is required if a "service" is provided and it is normally covered by Medicare.
Is a modifier required to indicate a ABN is signed?
I have one person who has always added a GA modifier, but recently had denials on it.
I have another person that never puts a modifier on a approved service even when ABN signed.
Which is correct?
SharonCollachi
Guest
No modifier is required when a service is provided that is normally covered by medicare.
Yes, however, do NOT have the patient sign an ABN if you do not reasonably think an ABN will be needed. You cannot do "just in case" ABNs.
Neither one.