Ob-Gyn Coding Alert

Learn how to use modifiers GA, GY, and GZ

You use advance beneficiary notices (ABNs) to let beneficiaries know of services that Medicare may not cover. But if you think ABNs are a piece of cake, you might be in for a surprise.

Take this quiz to see whether you can determine how to code the following two scenarios. See how you would code each scenario before you read the answers. Patient Didn't Understand ABN Question 1: We have a patient who came for her yearly well-woman exam and signed an advance beneficiary notice. As we suspected, her Medicare carrier won't pay for the services because these visits are only covered once every two years. Now the patient is saying she didn't understand what the ABN meant and is refusing to pay. What should I do?

Answer 1: The patient must pay. An ABN is a written notice a provider gives a Medicare beneficiary before furnishing items or services when the provider thinks that Medicare will not pay on the basis of medical reasonableness or medical necessity, says Kimberly Horn, CPC, medical coder and insurance coordinator for Shanbour, Goff and Associates in Oklahoma City. Remember these additional factors:

Making informed decisions: You-ve already put the patient on notice that Medicare coverage is unlikely. With this information, the patient is then in a better position as a healthcare consumer to make an informed decision about which services she may have to pay for out of pocket or through other insurance.

Mistake: When issuing an ABN, you must advise the Medicare beneficiary that she will be personally and fully responsible for payment of all items and services specified on the ABN if Medicare denies the claim, Horn says.  -According to Medicare's Web site, you should give this information to the patient before you take her back to the room.-

Be aware that you should consider an ABN improperly issued under the following circumstances:

- When the provider refuses to answer inquiries from a patient or the patient's authorized representative.

- When you used an ABN to shift liability to the beneficiary for items/services when you should consider full payment for those items/services already bundled into other payments. Your failure to provide a proper ABN in situations when you need one you may result in your practice being found liable.

In most situations, however, you should simply remind the patient that she has signed the ABN and that you explained at that time that she must pay if Medicare doesn-t.

Suggest that the patient contact Medicare if she has further questions. Master Modifiers GA, GY and GZ Question 2: I-m confused about when to use modifiers GA, GY and GZ. How should I use them with an ABN?

Answer 2: You [...]