Anesthesia Coding Alert

It's a fact of reimbursement life: Carriers don't always reimburse for anesthesia, especially for some monitored anesthesia-care (MAC) cases and other postoperative pain-management services. If a physician will provide services that the patient's carrier won't reimburse, it's important to have the patient sign a waiver or advance beneficiary notice (ABN) prior to the procedure stating that the patient will be responsible for payment. Knowing how to use ABNs and some new modifiers associated with them can make a big difference in a practice's bottom line.
 
CMS posted new ABN forms on its Web site late last year, along with instructions for their use. These simplified forms include one for general physician use, one designed for use with laboratory tests, and one that physicians can use to explain to patients which services Medicare never covers. Note: To view forms, visit hcfa.gov/medlearn/refabn.htm and go to "Medicare Announces New Patient Liability Notice."
Completing the ABN
It is important to clearly state on the ABN which healthcare items or services the physician does not expect Medicare to pay for and why. As the form's instructions state, "The items or services at issue must be described in sufficient detail so that the patient can understand precisely what items or services may not be furnished." The form also includes a box for the physician to complete stating the specific reason why he or she expects Medicare to deny payment.
 
Once the patient signs the ABN, it should be filed in the patient's medical record. A copy of the ABN does not need to be filed with the procedure claim, since the modifiers associated with the claim (described below) show that a waiver is on hand. "Since modifier -GA states that a waiver is on file, that's all that is necessary," explains Scott Groudine, MD, an Albany, NY, anesthesiologist. "Medicare wants to decrease paper billing because it increases their costs; it's much cheaper for them when electronic billing is done. You need to keep the ABN on file, but a paper claim does not have to follow."
Modifiers That Come Into Play
When the anesthesia service is provided, it should be coded with the applicable modifiers to indicate that the provider knows Medicare will not reimburse for the service. Modifier -GA (waiver of liability statement on file) was the first modifier established for reporting non-reimbursable services. It is used when physicians, practitioners or suppliers want to indicate that they expect Medicare to deny a service as not medically necessary and the patient has signed an ABN.
 
Groudine offers the following example of when modifier -GA would be appropriate for anesthesiologists to use. A healthy patient undergoes a colonoscopy in an area where a local Medicare policy states that anesthesia for [...]