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Medicare ABN

  1. Question Medicare ABN
    Medical Coding Books
    I work in an ophthalmology practice and was wondering if I need to use the Medicare ABN for any procedures/testing. I am a little unclear as to when to use the ABN and for what tests/procedures.
    Thank you for any help:-)

  2. #2
    Seacoast- Dover New Hampshire
    If it is not covered by Medicare then an ABN is not needed. That said, folks need to be told that MCR may not cover certain test that the MD has ordered. We have them sign it just in case something gets by us.
    Karen Barron, CPC
    Hampton New Hampshire Chapter

  3. Default
    Thank you. That is kind of what I thought but my doctor wanted me to double check.

  4. #4
    North Carolina
    Ophthalmology is not my specialty but maybe these links will be useful....

  5. #5
    Tampa, Florida
    Default ABN form
    for any procedures, vaccines, injections or labs done in the office, we always have pt sign the ABN form and keep it on file just in case it is not covered.

    hope this helps

  6. Default
    We were having patients sign them when we weren't sure if it would be covered. I was told by our Medicare rep that we couldn't do that. You only have a patient sign if your doctor believes that it not a medical necessity or you know Medicare won't cover it for sure.

  7. #7
    Default Abn
    Unfortunately, you can't do blanket ABN's. You need to check the LCD for your area and the NCD's to see if the procedure/test you want to perform is listed there. They give you the specific procedure's with CPT and any diagnoses that are determined to be medically necessary. If the diagnosis is not there, then you have them sign an ABN completely filled out. If any part of the ABN is missing, my understanding is it would be invalid.
    Anna Weaver, CPC, CPMA, CEMC
    Associate Auditor

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