AAOMS : AAOMS Newsletter: Changes to Advanced Beneficiary Notice of Non Coverage (ABN) Modifiers

Subject	Changes to Advanced Beneficiary Notice of Non Coverage (ABN) Modifiers
Source	AAOMS Newsletter
Publication	Coding Corner Jan/Feb 2010
Effective Date	Feb 1, 2010
Publish Date	Feb 1, 2010

Changes to Advance Beneficiary Notice of Non coverage (ABN) modifiers

OMSs billing Medicare need to be aware of a change affecting any claim submitted for a patient to whom the ABN has been provided. The ABN should still be provided to a Medicare patient prior to rendering a service that Medicare typically covers, but will likely deny on the particular occasion due to, for instance, the patient's diagnosis not meeting Medicare medical necessity criteria. What has changed is explained in MLN Matters article MM6563 (http://www.cms.hhs. gov/ContractorLearningResources/ downloads/JA6563.pdf). A new HCPCS level II modifier has been created to describe the voluntary use of the ABN while an existing modifier has been updated to reflect required use of the liability notice. In the past, there were two separate forms (ABN and Notice of Exclusion from Medicare Benefits (NEMB)) that helped distinguish the usage, however, they were consolidated in

2008. HCPCS modifier -GA has been revised to mean "waiver of liability statement issued as required by payer policy" and a new modifier, -GX, has been created to describe "notice of liability issued, voluntary under payer policy." An example of when the -GX modifier would be appended to a code on the claim form would be in the case of routine dentoalveolar surgery. Keep in mind, the claim technically would not have to be submitted if the service is one that is statutorily excluded from Medicare, such as extractions not prior to radiation treatment. If, however, a patient insisted the claim be filed, the -GY modifier (item or service statutorily excluded or does not meet the definition of any Medicare benefit) would appear in addition to the -GX modifier. Medicare will automatically assign beneficiary liability to any claim where the -GA or -GX is present. The new modifiers must be used effective April 1, 2010.