Wiki ABN "reason" codes question

[lgardner]

hi.
this is my first time posting here; I hope I'm posting in the right section.

thanks, in advance, for any help.

I'm trying to find out if a patient signs an ABN that includes a "reason" code of "B-Medicare does not pay for these tests as often as this" and it is discovered (after the test has been done and the patient is gone) the "reason" code should have been "A- Medicare does not pay for these tests for your condition", should the ABN be considered invalid?

if it were the other way around, the ABN states "A" and it turns out to be "B", I have no problem using the ABN...the patient chose to have the test done knowing that it would not be paid (although now it might be).

but if they think it just may be a frequency issue, wouldn't it be wrong to use the ABN if we know the code will not be covered?

I'd like to hear all opinions, but if anyone has seen an actual fact or some proof that it would or would not be considered invalid, I'd love a link to some documentation stating so.

thanks much.

 

[mhstrauss]

hi.
this is my first time posting here; I hope I'm posting in the right section.

thanks, in advance, for any help.

I'm trying to find out if a patient signs an ABN that includes a "reason" code of "B-Medicare does not pay for these tests as often as this" and it is discovered (after the test has been done and the patient is gone) the "reason" code should have been "A- Medicare does not pay for these tests for your condition", should the ABN be considered invalid?

if it were the other way around, the ABN states "A" and it turns out to be "B", I have no problem using the ABN...the patient chose to have the test done knowing that it would not be paid (although now it might be).

but if they think it just may be a frequency issue, wouldn't it be wrong to use the ABN if we know the code will not be covered?

I'd like to hear all opinions, but if anyone has seen an actual fact or some proof that it would or would not be considered invalid, I'd love a link to some documentation stating so.

thanks much.

Hi, and welcome to the Coding Forums!

Not sure if you've seen it or not, but this CMS Publication is a great resource for questions regarding ABN's.

http://www.cms.gov/Outreach-and-Edu...NProducts/downloads/abn_booklet_icn006266.pdf

As for your specifi question, I would be hesitant to use an ABN that didn't have the appopriate reason listed, because, IMO, that would make it invalid, and CMS states:

"If you do not issue an ABN or Medicare finds the ABN invalid, you may not bill the
beneficiary for the services, and you may be financially liable if Medicare does not pay."


Hope this helps!

 

[lgardner]

thanks Meagan!

I feel the same way, but others in my practice don't agree.

that's why I'm trying to find something definitive.

thanks for the link, too. I read that before I decided to come and pose my question to the forum.