Medicare & BMT evaluation testing

[Guest guest]

Our facility recently started using an edit system that tells our staff if a Medicare ABN is needed for a particular procedure when the diagnosis code is entered, and we’re finding that many tests are hitting the edits. For example, no cancer diagnosis seems to be allowed for HIV antibody or antigen screening, yet standards require that transplant patients be tested for that virus. There’s no diagnosis code for “Transplant Candidate” so we have to use the disease ICD-9. We’re being asked by our business office to have patients sign Medicare ABN forms, which seems unfair when these are medically necessary tests. We also don’t know if the test will actually be denied, or if the edit is just a “warning.” Has anyone else had any issues regarding Medicare coverage (or a need for an ABN) for PFT, stress echo, viral serologies, etc. when using a cancer diagnosis? Thanks in advance. GoldsteinBusiness Manager, Stanford BMT Program300 Pasteur Drive, H0101Stanford, CA 94305~ - direct~650.725-3117 - fax~ - BMT office ***This email and any attachments may contain confidential information for the use of the designated recipient(s) named above. If you are not the intended recipient, you are hereby notified that you have received this communication in error and that any review, disclosure, dissemination, distribution or copying of it or its content is prohibited. If you have received this email in error, please immediately notify Stanford University Medical Center at . ~Thank You.***