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required coding for ABNs

  1. Question required coding for ABNs
    Medical Coding Books
    Where I work, I am required to find a dx to cover everything for a Medicare
    patient, even if an ABN was signed. At first I balked, as it seemed like coding for financial gain, but then I accepted it, because you have the chance to do that when you appeal, after a claim has been denied. I am curious as to how others view this practice? Thanks!

  2. #2
    I view that practice as fraud actually.

    If they got an ABN it should have been due to the service being done for a non-covered reason. End of story.

    Laura, CPC, CEMC

  3. #3
    Columbia, MO
    I agree with Laura otherwise why get the ABN. I am very concerned about the statement "required to find a dx to cover everything" . You get the dx from the physicians documentation for the encounter, period. So my concern is just where are you looking for the dx?

    Debra A. Mitchell, MSPH, CPC-H

  4. Question
    We get the information from the chart,(anythig in it )the clinic notes,(from that day) or from the Doctor.
    The visit is run through code correct, and if the dx is not covered, we need to find something that covers it. If we do not, it turns up when it goes through the edits that the software does when it is sent out for billing.

  5. #5
    Columbia, MO
    For a physician encounter you may use the physician notes from that encounter not from anywhere in the chart, information obtained from the physician must be documented in the encounter note. Information may be obtained from elsewhere only for history and only if the doctor makes a reference to that history by stating the date the history is coming from.

    Debra A. Mitchell, MSPH, CPC-H

  6. Thumbs up
    I didn't think that was right. Thank you so much for the clarification. Now, I need to decide what to do with it.

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