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Thread: ABN needed or not?

  1. #1
    Join Date
    Apr 2007
    Grand Rapids

    Default ABN needed or not?

    AAPC: Back to School
    If a Medicare patient comes in for her yearly Gyn exam (G0101 & Q0091) and she is considered high risk, we would use dx code V15.89, along with the Q and G codes, my question is do we still have to get a signed ABN in this case?
    Leandra Tufts, CPC, CEMC, COBGC

  2. #2


    An ABN is only necessary if the service you are performing is "conditionally" covered by Medicare and it is believed that the service will be denied by Medicare for some other reason.

    If you feel the service is covered, an ABN is not necessary.

    Annette M. Roberts, CPC

  3. #3
    Join Date
    Apr 2007
    Harrisburg PA

    Default ABN or not

    In your situation you should not need one unless the patient is new, then you do not know if she has already had a high risk yearly GYN within the pass year.

    Here is where you can find information you may want on ABNs
    CMS IOM Pub 104 - Medicare's Claim Processing Manual

    40.3 - Advance Beneficiary Notice Standards

    There are two reasons to have a patient sign an ABN
    1. Medical necessity - the diagnosis does not or your are unsure it the diagnosis will support the medical necessity of the service being rendered
    2. Frequency - If the service is being performed more offend/sooner than allowed per guidelines. If a service has a frequency and you obtain an ABN it is not consider obtaining it for routine purposes.

    Keep in mind - Routine ABN Prohibition Exceptions
    having a patient sign an ABN for routine services that you know are not covered is for patient/physician relationship. It also helps the back end (A/R staff) from not receiving that phone call "why am I recieving this bill."

    Do not forget to use the appropriate modifier when obtaining a sign ABN

    Hope this helps


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