Ob-Gyn Coding Alert

Question: I noticed in a MLN Matters article that we're getting new advance beneficiary notice (ABN) modifiers. What are they, and when do we start using them?

California Subscriber

Answer: CMS will update the ABN modifiers effective April 1, according to MLN Matters article MM6563, dated Oct. 29. The ABN descriptors will read as follows:

• Modifier GA -- Revised to read, "Waiver of liability statement issued as required by payer policy." You'll use this when a required ABN was issued.

• Modifier GX -- New modifier defined as "Notice of liability issued, voluntary under payer policy." You'll append this modifier to claims when you've issued a voluntary ABN.

Currently, you can append modifier GA when you issue the ABN for either required or voluntary reasons.

Keep in mind: When you know an item is statutorily non-covered, you don't have to issue an ABN and submit the claim to your carrier with a modifier appended. You can collect for these services at the time of the visit.

For instance, if the patient presents to your ob-gyn practice for her annual exam, Medicare does not reimburse for anything but the pelvic and breast exam. That leaves the patient with the responsibility for paying for the non-covered part of the preventive service.

In that case, if you asked the patient to sign the ABN and be responsible for payment for the non-covered preventive service, you would append modifier -GX to codes 99387 (Initial comprehensive preventive medicine evaluation and management of an individual including an age- and gender-appropriate history, examination, counseling/anticipatory guidance/risk factor reduction interventions, and the ordering of appropriate immunization[s], laboratory/diagnostic procedures, new patient; 65 years and older) or 99397 (Periodic comprehensive preventive medicine re-evaluation and management of an individual including an age- and gender-appropriate history, examination, counseling/anticipatory guidance/risk factor reduction interventions, and the ordering of appropriate immunization[s], laboratory/diagnostic procedures, established patient; 65 years and older).

For more on the new ABN modifiers, visit www.cms.hhs.gov/MLNMattersArticles/downloads/MM6563.pdf.