Abn

Is there anywhere on the CMS website that identifies by CPT or HCPCS code what office procedures, DME, etc. require ABN's. We have been getting ABN's on all DME, casting, injections, aspirations because we do not know for certain that Medicare will cover these services. However, I don't want to require our patients to sign ABN's if it is not applicable. I just can't find a definitive answer.

Abn

Here's the link to the CMS website on ABNs in fee for service medicine:

http://www.cms.hhs.gov/BNI/02_ABN.asp#TopOfPage

In general, Medicare does not want you to get blanket ABN's. That is, to get an ABN for a service "just in case" Medicare doesn't cover it. You get an ABN when you believe that Medicare may not or will not cover for reasons of medical necessity, non-covered diagnosis codes, services at too frequent intervals or for experimental treatments. They warn the patient, in writing, before providing the service, that the service might not be covered. It allows you to hold the patient liable.

It would be incorrect to get ABN's on all of the services.

What services do you have being denied? What are the reason codes? Does it say "medicare does not pay for this service for this condition?" That is the type of service you need an ABN for.

You can search national and local coverage determinations, by service

http://www.cms.hhs.gov/mcd/index_list.asp?list_type=ncd

When to use an ABN

I have never seen any specific resource that directs the provider when to use an ABN by codes. However, I have blogged about this topic, which you can read here:

http://charleneburgett.wordpress.com/tag/abn/




Charlene Burgett, MS, CMA (AAMA), CPM, CPC, CMSCS

Administrator, North Scottsdale Family Medicine

POMAA National Advisory Board (www.pomaa.net)

Blog: www.charleneburgett.wordpress.com

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