Wiki Screening Spirometry?

[leebennie]

I've recently come under the services of a physician who does screening Spirometry (94010) for patients. The problem is that many of these patients are Medicare patients and the screening code he's using as a diagnosis does not meet Medicare's medical necessity guidelines. This is becoming a big bone of contention between this physician and the billing staff.

I've been looking into the Medicare-specific modifiers, GX, GY and GZ that could be appended to this service but I'm not sure which modifier would best fit the scenario. What this boils down to for me is whether 94010 actually requires an ABN when performed as a screening tool, or if this is voluntary. Any help is greatly appreciated.

 

[kvangoor]

An ABN should be used when the provider believes the service may not be covered due to medical necessity. I believe the GA modifer would be best for the situation you describe. I found some helpful information on my local medicare website.

http://wpsmedicare.com/j5macpartb/claims/submission/abn.shtml