Neurology & Pain Management Coding Alert

Question: Which modifier applies when the physician performed a noncovered service for a Medicare patient, but we didn't get an ABN? New Jersey Subscriber Answer: If the physician performed a non-covered service and there's no signed Advance Beneficiary Notice (ABN) on file, you should append modifier GZ (Item or service expected to be denied as not reasonable and necessary) to the CPT® code describing the non-covered service. The advantage to reporting modifier GZ is avoiding the potential for fraud and abuse allegations. This modifier tells Medicare that you know you're submitting the code for a non-covered service, and you expect them not to pay for it. Be forewarned, however, that modifier GZ claims might be subject to complex medical reviews, which can slow claims and create logjams in your billing processes. However, CMS has a new policy going into effect to deny those claims instantly. In black and white: "Effective [...]