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GA-GY-GZ Modifiers

  1. #1
    Kansas City, MO
    Default GA-GY-GZ Modifiers
    Medical Coding Books
    Is all this correct???

    GZ - an ABN should have been signed, but wasn't. Medicare denies and you cannot bill patient

    GY - a non-covered (excluded service) that you are submitting for a denial EOB only. (this non-covered can also be charged to patient and you do not have to send claim to medicare)

    GA - you are doing a covered procedure for a non-covered DX you have to get an ABN and use the GA or you have to write it off. You can bill patient if service is denied.

    Is it wrong to continually bill services to Medicare that we know will not be covered, without any type of Modifier? Say a certain office states they are too busy to deal with ABN, so they continually submit claims to MCR that are denied as not covered, or not medically necessary.(losing big time money!!)
    and someone else says this can cause a red flag to MCR, maybe indication that we are not following or don't know guidelines. (any truth to that-the "red flag" part)

    Linda Vargas, CPC, CPCO, CPMA, CPC-I, CEMC,CCC, AAPC Fellow
    PMCC Licensed Instructor
    2018 Chapter President, Kansas City, MO

  2. #2
    WPS Medicare has some great modifier educational sheets:

    One says the modifier isn't required (GY) and that the service will deny anyway, GZ looks like an informational modifier only. I'm not sure about "red flags" to Medicare but it sounds like there is lots of potential revenue loss by not obtaining an ABN and using the modifier so you can bill the patient when they are responsible.

    Maybe it would help if someone knew just how much money was being lost? Though sometimes it is hard to be "just" the coder or biller and have any say in things like that...
    Good luck.
    Pam Tienter, CPC, COC, CPC-P, CCS-P, CPMA, CPC-I, AAPC Fellow
    National Advisory Board Member 2018-2021, Region 6 Great Lakes
    Minneapolis AAPC Chapter, Education Officer 2018
    AHIMA ICD-10-CM/PCS Trainer
    AAPC National ICD-10 Trainer

  3. #3
    Columbia, MO
    do not forget about GX effective oct 1 2010! this is when you obtain an ABN for noncovered services. What I read, and now I am looking to see if I can get that notice to come up again, is that after an edcational period following April 1 2010, IF you submit a GA modifier for a covered service with a cover dx then the service will auto deferr to patient responsibility, and if you use the GX on a covered procedure the claim will deny for invalid modifer. Hmmmmmmmm

    Debra A. Mitchell, MSPH, CPC-H

  4. Default
    So, has anyone found a way around this? Your sort of damed if you do, and damed if you don't. We're having a hard time finding info on GX. Anyone
    else having similar problems? All our dexas are being denied with the GA modifier.

  5. #5
    Columbia, MO
    what dx are you using

    Debra A. Mitchell, MSPH, CPC-H

  6. Default
    733.90, 733.01,733.00 AND V49.81, pretty much everything that
    previously was covered. All had a signed ABN, and I used a GA modifier.

  7. #7
    Columbia, MO
    were the dexas for screening or because the patient is on drug therapy? and V49.81 is secondary only allowed. It could be the dx is not the correct medical necessity.

    Debra A. Mitchell, MSPH, CPC-H

  8. Default
    It seems as though they are not even looking at the dx, just the fact that
    there is a GA modifier is the reason not to pay. All of the dxs that I previously
    mentioned always covered the dexa before April 1st. There is some discussion
    to not use the modifier if the ABN has been signed, but I'm of the mind that that's probably not legal. Also, the GX code is not recognized by some of our software, and I'm wondering if thats because it doesn't go into effect until October?

  9. #9
    Columbia, MO
    You are correct in that you must use a modifier if you have a signed ABN, also The info I have shows the GX went into effect April1,
    But the same memo did say that the presence of the GA modifer would automatically default the line item to patient responsibility, could it be that they were not kidding? I honestly did not believe that would really happen.

    Debra A. Mitchell, MSPH, CPC-H

  10. #10
    Default GX Modifier
    The info I have is from an excel file downloaded from CMS. I don't know where the link is to now, but I looked into the file I have and it says that the GX is a voluntary liability notice: NOTICE OF LIABILITY ISSUED, VOLUNTARY UNDER PAYER POLICY, Coverage C, effective 4-1-2010.

    I also have this on the same excel sheet: GA Required liability notice WAIVER OF LIABILITY STATEMENT ISSUED, AS REQUIRED BY PAYER POLICY Coverage C 4/1/2010

    Hope it helps
    Last edited by KellyLR; 07-07-2010 at 04:01 PM. Reason: added info

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