Pathology/Lab Coding Alert

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

Maryland Subscriber

Answer: CMS will update the ABN modifiers effective April 1, according to MLN Matters article MM6563. 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 you have the patient sign a required ABN.

• 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 physician orders a screening lab test in the absence of disease signs or symptoms that is not part of Medicare’s preventive services, the test will be statutorily non-covered. That leaves the patient with the responsibility for paying for the non-covered lab test.

In that case, if the physician asked the patient to sign the ABN and be responsible for payment for the noncovered lab test, you would append modifier GX to the lab test code.

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