Wiki GY modifier vs GZ

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kbarron

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Conversation re these two. My understanding is that pt does not sign ABN because medicare never covers the Diagnosis and pt is responsible for payment. GZ is that ABN is signed and test Provider orders may not be paid by Medicare because its not medically necessary. Looking for good conversation on these subjects.
 
http://www.cms.hhs.gov/Transmittals/Downloads/R1142CP.pdf

Based on the above it looks like GZ is when you know there should have been an ABN completed but it wasn't. The patient would not be liable for any charges and medicare would not pay if the GZ is used.

GY is for services that are never covered to be processed faster. At least that it my understanding.

Example of GY usage would be a medicare patient goes to a chiropractor and gets CMT of the spine that qualifies as active treatment but also gets their knees adjusted. You would use the GY on the extremity code so they could go together and be processed correctly the first time. Or so I have been told.

If you are doing a covered procedure for a non-covered DX you have to get an ABN and use the GA or you have to write it off.


Laura, CPC
 
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