Wiki Please explain why we would use GY

[gmitch02]

Ok I hope someone could help explain why we would use a GY modifier? It should be simple but I maybe over thinking the definitions.

GA lets them know we have a wavier on file for a non-covered service or supply and GZ lets Medicare know we did not get an ABN for a non-covered service. So why use GY when all it does is let Medicare know we know it is not covered.

Our billing company has on our encounter form to append the GY to show we have a waiver for a non-covered charge. I don't think this is correct. Please save my brain cells on this one.

Thanks

Still learning

 

[rkmcoder]

(These are my opinions and should not be construed as being the final authority. Other opinions may vary.)

We use the GY modifier for Medicare billing. One reason is that it is our policy to bill all carriers for all procedures, but since Medicare does not reimburse for certain procedures, then we append the GY modifier. Another reason is that Medicare will deny an entire claim unless they see certain procedures - even though they do not pay for those procedures! As an example - Medicare does not pay for fluoroscopic guidance (77003), but a few pain management injections require fluoro guidance to be paid. If we did not bill the fluoro (even though it will not be paid) then the entire claim would be denied. In this case, we must bill the fluoro (with a GY modifier) in order to get paid.

Richard Mann, your pain management coder
rkmcoder@yahoo.com

 

[gmitch02]

Thank you - that does make sense. So I take it our billing company is wrong with their definition.

 

[jls]

Gy modifier

We use the GY to get a clean denile from Medicare. For example, when we bill for some DME that medicare will not cover, we need a clean denile so that the secondary will pay their portion.