tci Part B Insider - 2005 Issue 44

NEUROSURGERY: Uncover How 2 Non-Covered Services Can Pay Off

Hint:  ABN/modifier combo will guarantee payment--and protect youWhen it comes to reimbursement for non-covered procedures, your best bet is to provide patients with notices that outline patients' responsiblitiy. These examples detail how modifiers GA (Waiver of liability statement on file) and GY (Item or service statutorily excluded or does not meet the definition of any Medicare benefits) help you receive optimal payment from patients. Example #1: A patient with chronic lower-back pain requests an epidural injection (62311--Injection, single [not via indwelling catheter], not including neurolytic substances ... lumbar, sacral [caudal]). He's already received six injections within the last year, which...

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