Tuesday, September 20, 2016

Modifier G7, AA, AB and AD - Usage Guide

Providers Billing on the CMS 1500 Claim Form

Use the appropriate procedure/diagnosis code from the list above and the most appropriate modifier from the list below:

G7 - Termination of pregnancy resulting from rape, incest, or certified by physian as life-threatening.


Billing for Abortion Services


Abortions are not covered under the Medicare program except for instances where the pregnancy is a result of an act of rape or incest; or the woman suffers from a physical disorder, physical injury, or physical illness, including a life endangering physical condition caused by the pregnancy itself that would, as certified by a physician, place the woman in danger of death unless an abortion is performed.

Submit the HCPCS Modifier G7 with the following CPT codes when documentation supports the circumstances listed above:

59840 through 59841

59850 through 59852

59855 through 59857

59866


Providers Billing on the UB-04 Claim Form

Use the appropriate procedure/diagnosis code from those listed previously and the most appropriate condition code from the list below:

AA Abortion Due to Rape
AB Abortion Due to Incest
AD Abortion Due to Life Endangerment


In addition to the required coding, all claims must be submitted with the required documentation. Claims submitted for induced abortion-related services submitted
without the required documentation will be denied.

Induced Abortions to Save the Life of the Mother

Every reasonable effort to preserve the lives of the mother and unborn child must be made before performing an induced abortion. The services must be performed in a licensed health care facility by a licensed practitioner, unless, in the judgment of the attending practitioner, a transfer to a licensed health care facility endangers the life of the pregnant woman and there is no licensed health care facility within a 30 mile radius of the place where the medical services are performed.


“To save the life of the mother” means:

The presence of a physical disorder, physical injury, or physical illness, including a life-endangering physical condition caused by or arising from the pregnancy itself, as determined by the attending practitioner, which represents a serious and substantial threat to the life of the pregnant woman if the pregnancy is allowed to
continue to term.

The presence of a psychiatric condition which represents a serious and substantial threat to the life of the pregnant woman if the pregnancy continues to term.

All claims for services related to induced abortions to save the life of the mother must be submitted with the following documentation:

** Name, address, and age of the pregnant woman
** Gestational age of the unborn child
** Description of the medical condition which necessitated the performance of the abortion
** Description of services performed
** Name of the facility in which services were performed
** Date services were rendered

And, at least one of the following forms with additional supporting documentation that confirms life-endangering circumstances:

** Hospital admission summary
** Hospital discharge summary
** Consultant findings and reports
** Laboratory results and findings
** Office visit notes
** Hospital progress notes

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