General Surgery Coding Alert

Got an itch to make a switch on an ABN? Proceed with caution

When it comes to manipulating its ABN-G form, Medicare is like a stern but understanding parent: unbending on certain issues, yet sensible enough to be flexible when the situation calls for a slight alteration.

If you make a change to an area Medicare has deemed "off-limits," the ABN will likely be defective, said Thomas Bartrum, JD, attorney at Baker, Donelson, Bearman & Caldwell in Nashville, Tenn., at the American Health Lawyers Association's 2003 Institute on Medicare and Medicaid Payment Issues.

However, Bartrum said each ABN-G also has some areas that the provider can, and in some cases should, customize. The header should be altered to include your practice's logo (if it has one), along with the practice name, address and telephone number. All type must be in 12-point Arial or Arial Narrow font.

The "Items or Services" box can be expanded if the space provided is not adequate. The same holds true for the "Because" box. No matter what you do, don't change any captions in the boxes; you can alter the form only for space, not content.

Always use caution when tinkering with the form. While Medicare will allow you to alter the ABN, under no circumstances will it accept an ABN of more than one page. You can print out an ABN on legal-size paper to give yourself more space, but make sure you're only submitting a single sheet.

Do not alter any area of the ABN-G form not mentioned above, Bartrum said. Fill those areas out completely and do not change them for any reason -- unless your intention is to render the ABN useless. For complete instructions on using ABNs, go to www.cms.gov/manuals/pm_trans/ab02168.pdf.