Cardiology Coding Alert

Question: Is there a modifier I can use to let Medicare know I have an ABN on file?


Washington Subscriber

Answer: Modifier GA (Waiver of liability statement on file) should let Medicare carriers know you have an advance beneficiary notice (ABN) on file.

Example: A patient opts to have a cardiac CT angiography (CTA) for a reason not listed in your carrier's coverage policy, so your practice makes sure to get an ABN on file. The ABN instructs the patient that you expect that Medicare won't pay for the service and the patient must choose whether he is willing to receive the service knowing he may have to pay. 

The ABN should include an estimate of the cost, and you should have the patient sign and date the document.

You report 0148T (Computed tomography, heart, without contrast material followed by contrast material[s] and further sections, including cardiac gating and 3D image post processing; cardiac structure and morphology and computed tomographic angiography of coronary arteries [including native and anomalous coronary arteries, coronary bypass grafts], without quantitative evaluation of coronary calcium) and append GA
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Tip: If you don't get a signed ABN, append modifier GZ (Item or service expected to be denied as not reasonable and necessary) to let Medicare know you're aware the payer is unlikely to cover the service but you don't have an ABN.

Also ensure that you don't obtain "blanket" ABN forms from all or most of your patients. You should only get ABNs when your practice has ample reason to believe that Medicare will deny the claim. 

You Be the Coder and Reader Questions were prepared with the assistance of Jim Collins, ACS-CA, CHCC, CPC, CEO of the Cardiology Coalition and compliance manager for several cardiology groups around the country; and reviewed by Jerome Williams Jr., MD, FACC, a cardiologist with Mid Carolina Cardiology in Charlotte, N.C.