Q/A: Am I Supposed to List the Frequency and Duration on the ABN?

Categories:   Compliance   Medicare   Chiropractic  

To answer that question, let's look at the official instructions with emphasis added. It's like the non-participating provider instructions to strikeout certain text. There is some ambiguity which leaves the door open for some interpretation.

"The notifier must list the specific items or services believed to be noncovered under the header of Blank (D).

• In the case of partial denials, notifiers must list in Blank (D) the excess component(s) of the item or service for which denial is expected.
• For repetitive or continuous noncovered care, notifiers must specify the frequency and/or duration of the item or service. See § 50.14.3 for additional information.
• ..."

Section 50.14.3 states the following:

"50.14.3 - Repetitive or Continuous Noncovered Care
(Rev.1587, Issued: 09-05-08, Effective: 03-03-08, Implementation: 03-01-09) 
Notifiers may give a beneficiary a single ABN describing an extended or repetitive course of noncovered treatment provided that the ABN lists all items and services that the notifier believes Medicare will not cover. If applicable, the ABN must also specify the duration of the period of treatment. If during the course of treatment additional noncovered items or services are needed, the notifier must give the beneficiary another ABN. The limit for use of a single ABN for an extended course of treatment is one year. A new ABN is required when the specified treatment extends beyond one year."

Notice the "if applicable" used in conjunction with the "must". Because CMT is a covered benefit which is not always payable (i.e., maintenance care) it comes down to semantics. So go ahead and state the duration and frequency, but we recommend being a little more vague and saying "up to" or "approximately" before listing a number of visits per year (e.g., up to 24 visits/12 months).

COVID vaccine changes due to the end of the PHE as of November 1, 2023 are addressed in this article.

2023 brought quite a few changes to Evaluation and management (E/M) services. The significant revisions as noted in the CPT codebook were welcome changes to bring other E/M services more in line with the changes that took place with Office or Other Outpatient Services a few years ago. As part of CMS’ Medicare Learning Network, the “Evaluation and Management Services Guide” publication was finally updated as of August 2023 to include the changes that took place in 2023. If you take a look at the new publication (see references below),....

When EKGs are performed in the facility setting or even in the physician's office, what are the requirements for reporting the service and who gets credit for scoring data points for Evaluation and Management (E/M) medical decision making (MDM)? Let's take a look at a few coding scenarios related to EKG services to get a better understanding of why this can be problematic.

Coders often find themselves unsure of when to report a sign or symptom code documented in the medical record. Some coders find their organization has an EHR that requires a working diagnosis, which is usually a sign or symptom, be entered to order a test or diagnostic study or image. Understanding the guidelines surrounding when signs and symptoms should be reported is the first step in correct coding so let's take a look at some scenarios.

Diabetes is a chronic disease that just seems to consistently be increasing instead of improving resulting in a constant endeavor by medical researchers to identify causal effects and possible treatments. One underlying or precipitating condition that scientists have identified as a precipitating factor in the development of diabetes is insulin resistance, which is a known metabolic disorder. As data becomes available through claims reporting, additional code options become possible with ICD-10-CM.

Sometimes we receive questions regarding documentation requirements for specific codes or coding requirements and we respond with information and resources to support our answers. The following question was recently submitted: Are providers required to report postoperative services on claims using 99024, especially if there is no payment for that service? What documentation is required if you are reporting an unrelated Evaluation and Management (E/M) service by the same physician during the postoperative period? 

Gastroesophageal reflux disease or GERD for short, is a disease that impacts millions of Americans on a weekly basis. Symptoms are uncomfortable, as are some of the tests used to diagnose it, but understanding the disease, tests, and treatments helps us better understand how to code the disease using ICD-10-CM codes.