Wiki Medicare Mole/Wart Removals

[CMW]

I work in a Physicians office and we do a lot of removals of Moles and Warts (17110-17000) We do have the patient sign a consent but not and ABN. However Medicare denies the procedure due to NOT MEDICALLY NECESSARY....so then we are having to take the balance as an adjustment. Would a GA MODIFIER be appropriate for this kind of service? (then we could at least apply the balance to patient responsability) or is there a better MODIFIER that would work and what documentation would we need?

Thank you all in advance!!
Happy Friday!!

 

[lmartien]

Mole/Wart removal

CMW,

In these types of instances (patients who come in for mole or wart removal) I would recommend having the patient sign an ABN when there is no clear medical necessity for the procedure. Otherewise, you might review with your doctor dictation practices that might support medical necessity.

I hope this helps,

Linda

 

[mitchellde]

I work in a Physicians office and we do a lot of removals of Moles and Warts (17110-17000) We do have the patient sign a consent but not and ABN. However Medicare denies the procedure due to NOT MEDICALLY NECESSARY....so then we are having to take the balance as an adjustment. Would a GA MODIFIER be appropriate for this kind of service? (then we could at least apply the balance to patient responsability) or is there a better MODIFIER that would work and what documentation would we need?

Thank you all in advance!!
Happy Friday!!

A GA modifier requires a signed ABN be obtained prior to the procedure. If your dx code does not indicate medical necessity then your provider should have had a signed ABN prior to the procedure beign performed.

 

[CMW]

Thank you....Mitchellde