Otolaryngology Coding Alert

Question: Is there a modifier for billing a noncovered service to indicate the patient signed a waiver acknowledging the service is not covered? We are performing computerized dynamic posturagraphy (CDP) testing, and our Medicare carrier (NHIC) does not pay for this service.

Maine subscriber

Answer: Modifier -GA specifies the patient signed an advance beneficiary notice (ABN), which indicates that he or she was informed the procedure or service performed might not be covered by Medicare, says Randa Blackwell, a coding and reimbursement specialist with the department of otolaryngology at the University of Maryland in Baltimore.

In the above situation, however, an ABN need not be obtained and, therefore, the -GA modifier does not need to be attached. Although CDP, a test for vertigo that is administered to individuals with retrocochlear lesions and other labyrinthine procedures, can be very useful in identifying malingerers, Medicare claims the tests efficacy has not been sufficiently documented and will not pay for the service. And Medicare requires providers to have patients sign an ABN only for services that might not be covered.

For example, the patient should sign an ABN prior to an audiologic test as acknowledgment that the service may not be paid (if Medicare determines the test was for a hearing aid, for example, or if the test exceeds frequency guidelines).

There are, however, no restrictions on obtaining signed ABNs, and Blackwell recommends having patients sign ABNs for noncovered services as well, even though it is not necessary. By doing so, the otolaryngologist can prove that the patient was aware the service was noncovered.