General Surgery Coding Alert

Question: Our office obtains advance beneficiary notices each time there is some doubt about whether Medicare will pay for a particular service. Do we also have to get a signed ABN if we know for certain that Medicare will not pay for a service?

Rhode Island Subscriber

Answer: Not if you're sure Medicare won't pay. If you have found some official documentation from Medicare stating that it never reimburses for a service, an ABN is not necessary.

"ABNs are designed for potentially noncovered Medicare services; it's only for those questionable reimbursement areas where Medicare may not pay," says Kathryn Cianciolo, RHIA, CCS, CCS-P, a coding consultant for more than 20 years from Waukesha, Wis.

Tip: Make sure Medicare doesn't already have a reimbursement policy on a procedure before you ask a patient to sign an ABN. Obtaining signed ABNs for services that Medicare does not pay for is an unnecessary expenditure of time and resources.

-- Reader Question and You be the Expert were reviewed by Catherine Brink, CMM, CPC, president of Healthcare Resource Management in Spring Lake, N.J.