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GA Modifier Question

  1. Default GA Modifier Question
    Medical Coding Books
    I code for an ASC that performs mainly colonoscopies, I want to make sure I
    understand the proper use of the GA Modifier. Should we apply the GA modifier to all procedures that we have an ABN for ???

    Thanks for any responses,


  2. #2

  3. Default Ga modifier
    At our asc, this is what we do......

    On all colonoscopies sched with screening diagnosis only-- we obtain an abn that informs the patient how screening colonoscopies are viewed by medicare-- our abn lists both low risk and high risk screening colonoscopies and how often medicare allows such testing. Our abn also gives the cost to the patient if medicare denies, as well as the cost if medicare does pay. (for screening medicare does not allow 80/20, they allow 75/25) this abn also states that if the patient has had another screening colonoscopy in the specified time frames allowed for low or high risk categories, and they forget to inform us, that medicare will deny this service as it has already been performed within the established time frame.

    We do not have a pt sign this abn if they have been scheduled with any diagnosis that is not screening. Any other diagnosis outside of screening necessitates medical necessity per medicare lcd's for your area.

    We have found that this abn explains to the patient exactly how medicare treats the screening colonoscopy, better than anything else we have tried. Pt then signs, feeling good about knowing what medicare will cover. Since we started doing this, we have had great success in communication with our patients. We also have them sign a separate abn, specifically for anesthesia.

    We are also implementing this with medically necessary blepharoplasty.

    Hope this helps

    caprice, cpc

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