Why to use GZ: It happens to even the best-run medical practices – the doctor has just carried out a non-covered service and there is no ABN on file.
If you should have had a patient sign an ABN but failed to do so, you should add modifier GZ (Item or service expected to be denied as not reasonable and necessary) to the CPT code describing the non-covered service the doctor provided. The advantage to reporting modifier GZ is to avoid the potential for fraud and abuse charges – by adding this modifier, you are telling Medicare that you know you carried out a non-covered service and you know they are not going to pay for it.
What the just-in rule means: Previously, your modifier GZ claims were potentially subject to complex medical reviews, which can slow claims and create logjams in your billing processes. But then the agency's new policy will ensure that these claims will be denied right away.
In writing: Effective for dates of service on and after July 1 this year, contractors shall automatically deny claim line(s) items submitted with a GZ modifier. Your explanation of benefits will list the denial codes CO and 50 (these services are non-covered services as this is not deemed a ‘medical necessity' by the payer.)
Plan beforehand: Do not allow yourself to resort to modifier GZ. You should have a policy in place to collect ABNs when necessary. For more on this and to read Transmittal 2148, visit a medical coding guide like http://supercoder.com/.
If you should have had a patient sign an ABN but failed to do so, you should add modifier GZ (Item or service expected to be denied as not reasonable and necessary) to the CPT code describing the non-covered service the doctor provided. The advantage to reporting modifier GZ is to avoid the potential for fraud and abuse charges – by adding this modifier, you are telling Medicare that you know you carried out a non-covered service and you know they are not going to pay for it.
What the just-in rule means: Previously, your modifier GZ claims were potentially subject to complex medical reviews, which can slow claims and create logjams in your billing processes. But then the agency's new policy will ensure that these claims will be denied right away.
In writing: Effective for dates of service on and after July 1 this year, contractors shall automatically deny claim line(s) items submitted with a GZ modifier. Your explanation of benefits will list the denial codes CO and 50 (these services are non-covered services as this is not deemed a ‘medical necessity' by the payer.)
Plan beforehand: Do not allow yourself to resort to modifier GZ. You should have a policy in place to collect ABNs when necessary. For more on this and to read Transmittal 2148, visit a medical coding guide like http://supercoder.com/.
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