Modifier -GA is used to indicate that a waiver of liability statement that is required by the payer is on file. Modifier -GX is used to describe a voluntary waiver of liability. Use -GY to describe an item or service that is statutorily excluded or that does not meet the definition of any Medicare benefit. Use -GZ to describe an item or service expected to be denied as not reasonable and necessary.
Denise Williams, RN, CPC-H, AHIMA-approved ICD-10-CM/PCS trainer and AHIMA ICD-10-CM/PCS ambassador, and Steven Espinosa, CCS, AHIMA-approved ICD-10-CM/PCS trainer, answer questions about the 2014 changes to CPT® coding for gastrointestinal procedures.
Sarah L. Goodman, MBA, CHCAF, CPC-H, CCP, FCS, president/CEO and principal consultant for SLG, Inc., of Raleigh, N.C., and Susan E. Garrison, CHCA, CHCAS, CCS-P, CHC, PCS, FCS, CPAR, CPC, CPC-H, executive vice president of Healthcare Consulting Services at Med Law Advisors in Atlanta, Ga., review two case studies to first determine whether the right codes were reported, then whether a modifier would be necessary and appropriate.
Susan E. Garrison, CHCA, CHC, CCS-P, CPC, CPC-H, PCS, FCS, CPAR, executive vice president of Healthcare Consulting Services at Magnus Confidential in Atlanta, GA and Shelley C. Safian, PhD, MAOM/HSM, CCS-P, CPC-H, CPC-I, CHA, AHIMA-Approved ICD-10-CM/PCS Trainer, president of Safian Communication Services, Inc., near Orlando, answered these five pain management coding questions as part of HCPro’s “Outpatient Pain Management Coding for Diagnoses and Procedures” audio conference.
Payers often refer to these examples to determine the appropriate level of service for an emergency medicine claim. Caral Edelberg, CPC, CPMA, CAC, CCS-P, CHC, AHIMA-Approved ICD-10-CM/PCS Trainer, president of Edelberg Compliance Associates of Baton Rouge, La., created this reference chart of examples for both CPT and American College of Emergency Physician Guidelines. If your claim is consistent with a case example but coded differently, be sure you have the supporting information in the record.
Jugna Shah, MPH, founder and president of Nimitt Consulting, and Valerie A. Rinkle, MPA, Associate Director, Healthcare for Navigant Consulting answered these five additional questions about injections and infusions coding.
Kimberly Anderwood Hoy Baker, JD, director of Medicare and Compliance for HCPro, a division of BLR, in Danvers, Massachusetts, provides examples for using modifier –L1 when reporting laboratory services in the ED.
