Primary Care Coding Alert

Question: A Medicare patient came to our office for screening laboratory tests in addition to his annual well visit. Do we need to ask him to sign an advance beneficiary notice (ABN) even though the patient should know that Medicare never covers the screenings?

Answer: Yes, you should give the patient an ABN and explain that he will be responsible for covering the screening tests because Medicare doesn't.

Don't assume that patients know which tests are for screening (and therefore not covered) and which are for diagnostic purposes. If you don't ask the patient to sign an ABN, you have no proof that the patient knew he was having a screening test and was financially responsible.

Consideration: Sometimes your physician might provide a service that Medicare would pay under different circumstances. For example, 85025 (Blood count; complete [CBC], automated [Hgb, HCt, RBC, WBC and platelet count] and automated differential WBC count) sometimes might be payable because of the patient's diagnosis. In the circumstance where the physician orders 85025 for screening rather than diagnostic purposes, you either ask the patient to sign an ABN or you may not get to collect anything for the service.