An ABN must include the service that may be denied, an estimated cost of the patient’s responsibility if Medicare denies the service and the response for the potential denial. Generic ABNs are not allowed. Signing of the ABN cannot be obtained during a medical emergency. The patient must be stable. The ABN must be signed prior to providing the service.

The injection given is Kenalog-10 eliminating multiple choices C and D. 40 mg of the Kenalog-10 was given. Code J3301 is reported for 10 mg so it will have to be reported four times to cover 40 mg.

Patient is not having a flexible sigmoidoscopy performed for the colorectcal cancer screening, eliminating multiple choice A. The screening for the cancer is being performed via barium enema instead of a colonoscopy. This eliminates multiple choices B and D. This patient is qualified by Medicare to be a high risk by having a history of ulcerative colitis. An individual with ulcerative enteritis or a history of a malignant neoplasm of the lower gastrointestinal tract is considered at high-risk for colorectal cancer, as defined by CMS.

Answer B is the only example of unbundling of CPT® which would result in a fraudulent claim. According to National Correct Coding Initiative (NCCI) and CPT® coding guidelines, a biopsy performed on the same lesion as an excision during the same encounter is an incidental service and is not reported separately. If ultrasound guidance is performed for a liver biopsy, it is billable. X-rays performed in a physician’s office do not require modifier 26, because the physician owns the equipment and performs the interpretation, he bills the global service. Lab panels can be reported with additional lab tests that are not listed in a lab panel.

The selection of the code is based on the materials used, the length of the cast, and the age of the patient. The patient being 10 years-old getting a short arm fiberglass cast guides you to select code Q4012.