My general surgeon has been doing Lap Bands for patients for almost a year, he does not yet have the Physician of Excellence distinction. We also do not have a Center of Excellence in our area yet to do the procedures for Medicare patients. However, we have several Medicare patients willing to pay for the procedure to be done at this time, instead of waiting for our facilities to meet the Excellence criteria.
I am under the impression that as long as my physician obtains an ABN for the patients and the facility also has an ABN for the patient, we could then proceed with surgery and the patient will be found responsible for the charges. I would code my procedure with the appropriate ABN modifier, the hospital does the same so that Medicare considers the claim but makes the patient responsible.
Has anyone else had experience in this situation? Please respond by e-mail to with any helpful information you may have. We are also interested in information related to any post-op complications with regard to how Medicare would handle charges and what the patient would need to be aware of as far as what additional charges could be involved for a worst case scenerio.