Urology Coding Alert

Answer 1: D. All of the above.

Answer 2: False. Without a valid ABN, you can collect for statutorily excluded services, but you cannot hold the patient responsible for charges Medicare denies as not medically necessary.

Answer 3: True. Now CMS accepts the new ABN for either purpose, noting that "the revised version of the ABN may also be used to provide voluntary notification of financial liability." This means you can use the new ABN form when you would have used an NEMB in the past.

Answer 4: C. Choose modifier GZ (Item or service expected to be denied as not reasonable and necessary) if you believe the carrier will deny an item or service as not reasonable and necessary and the beneficiary hasn't signed the ABN. You'll append modifier GA (Waiver of liability statement on file) to indicate that you expect Medicare to deny a specific service as not reasonable and necessary and you have an ABN signed by the beneficiary on file. Modifier GY (Item or service statutorily excluded, does not meet the definition of any Medicare benefit or, for non-Medicare insurers, it is not a contract benefit) applies when Medicare excludes the service, and you're using the new ABN as you would have used the NEMB in the past.

Answer 5: Yes. Medicare only covers an annual prostate-specific antigen (PSA) test for males over age 50. If your urologist orders (or the patient requests) a screening PSA before the 12-month time period passes, you'll need an ABN stating that the patient will pay the charges. If Medicare paid for a screening PSA test on March 15, 2009, it will not pay for another screening PSA test for the same patient until March 1, 2009, so you need an ABN for the Feb. 2 PSA test.

-- Answers provided or reviewed by Melinda S.Brown, CMBS, insurance biller for a primary-care provider in Kennewick, Wash.