Urology Coding Alert

Question: A Medicare patient came into our practice to see his urologist. The physician performed a service that Medicare does not cover. How should I report this visit?

Oregon Subscriber

Answer: If your practice did not give an advance beneficiary notice (ABN), which you will keep on file, to the patient to sign prior to the service, you should append modifier GZ (Item or service expected to be denied as not reasonable and necessary) to the procedure code that describes the non-covered service.

To avoid the possibility for fraud and abuse allegations from the patient and/or family, you should have the signed ABN on file. Modifier GZ communicates that you are claiming a non-covered service, and that you realize Medicare will not pay for the service.