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ABN and Routine Foot Care

  1. #1
    Default ABN and Routine Foot Care
    Medical Coding Books
    If a practice provides routine foot care to patients with medicare and medicaid and the patient has non covered dx according to medicare standards, is an ABN required for the visit or is it not required based on the fact that it is an excluded service and we can go ahead and just bill medicaid for the visit?

  2. #2
    Location
    Louisville, KY
    Posts
    1,101
    Default
    I believe the ABN must be signed prior to service provision, and appropriate modifier assigned to the code descriptor.

    The purpose of the ABNs is to afford patients the opportunity to make informed healthcare consumer decision, understanding they will be required to cover the cost.

    Formerly, in a practice that I worked in, if either the service was non-covered or the diagnosis did not substantiate the service (according to LCD, NCD or LMRP guidelines), an ABN was provided to the patient. This worked qutie effectively from a number of standpoints, including compliance.

  3. #3
    Default Abn And Foot Care
    What about the information set forth by the UMD below?

    http://www.umd.nycpic.com/ABN_partI.html

    H. ABN Standards for Items and Services for Which ABNs Are Not Required.--Physicians and suppliers need use ABNs only when Medicare is expected (or certain) to deny payment on the basis of one of the following statutory exclusions: §1862(a)(1) & (9); §1834(a)(17)(B); §1834(j)(1); and §1834(a)(15) of the Act. ABNs are not required in the case of statutorily excluded items and services not listed above. Examples of exclusions for which ABNs are not required include, but are not limited to:


    Personal comfort items;
    Routine physicals and most tests for screening;
    Most shots (vaccinations);
    Routine eye care, eyeglasses and examinations;
    Hearing aids and hearing examinations;
    Cosmetic surgery;
    Most outpatient prescription drugs;
    Orthopedic shoes and foot supports (orthotics);
    Dental care and dentures (in most cases);
    Routine foot care and flat foot care;

  4. #4
    Location
    Louisville, KY
    Posts
    1,101
    Default
    Well, I guess we've got our answer!

    Thanks for sharing that. I was unaware . . . perhaps a change since my days at that practice.

    Regardless, this is good to know and I appreciate your passing it on.

  5. #5
    Default Thank you
    Thank you for your help, I just wanted to verify my interpretation with a certified coder. I'm still learning

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