Pulmonology Coding Alert
ABN May Be Necessary on Spirogram Screen
Question: Would this be a case for an advance beneficiary notice (ABN), or are we missing something here? We're not sure what we should do, but this is a growing concern as more requests come in. Michigan Subscriber Some contractors, such as TrailBlazer, cover the tests required for monitoring the effect of drug therapy for medications with the potential for pulmonary toxicity (www.trailblazerhealth.com/Policies/Local%20Coverage%20Determinations/Default.aspx?id=2783). Other Medicare carriers, such as Highmark, recognize the importance of, and cover the tests for, establishing baseline values (www.highmarkmedicareservices.com/policy/partb/m1/m73a.html). Best bet: Non-Medicare payers may choose to follow Medicare, or they may deny all spirometry services absent signs, symptoms, or cardiopulmonary conditions considering them as not reasonable and necessary. Even with coverage policies in place, the contractors may not pay the claim upon initial submission. An insurer may reject the claim, awaiting supporting documentation from the provider, or simply deny the service, leaving the provider to manage his way through the appeal process. Supporting documentation should include the spirometry tracing and physician interpretation, as well as the progress note that identifies the care plan for inhaled insulin therapy.
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Pulmonology Coding Alert
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