Oncology & Hematology Coding Alert

Question: I would like to know what modifier to use when a patient signs an ABN for an injectable drug that will not be covered by Medicare.

Illinois Subscriber

Answer: Modifier -GA(Waiver of liability statement on file) lets Medicare know that the patient has been notified prior to receiving and accepting the service that the service may not be covered. To bill the patient appropriately, you must have an ABN on file and recorded on the claim to Medicare.

If the patient refuses to sign the ABN and accepts or receives the treatment, you can still bill the patient if you note on the ABN that the patient was notified that the service may not be covered and refused to sign. As long as you prove that you made a valid attempt to notify the patient, you're in the clear.