# ABN needed or not?



## Leandra (Feb 2, 2012)

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?


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## klamroberts290 (Feb 3, 2012)

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
amroberts290@bellsouth.net


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## CBaer (Feb 21, 2012)

*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
http://www.cms.gov/manuals/downloads/clm104c30.pdf

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 40.3.6.4 - 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

cheryllb


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