Instructions for Advance Beneficiary Notice (ABN) for Medicare Patients

Step 1. Determine the test to be ordered (Pap and/or Molecular tests) and indicate all medically appropriate ICD-9 codes for all tests that accurately reflect the patient’s condition or symptoms and therefore the diagnostic purpose for ordering the test. Check the appropriate diagnosis code for the Pap test and/or the molecular test from the list of diagnosis codes on the PCNM requisition; or, if the appropriate ICD-9 code for the test(s) is not provided on the requisition, write the appropriate diagnosis code on the requisition (refer to the following reference guides on this Web site to choose from a comprehensive listing of diagnosis codes: Pap ICD-9 Codes for Medicare, Medicaid, and All Insurances and Molecular ICD-9 Codes for Medicare and All Insurances).

Step 2. For all Pap and molecular tests, review with your patient the Advance Beneficiary Notice (ABN) form:

1. Write your patient’s name and Medicare number on the top of the form.
2. Check off which test(s) you are ordering for the patient.
3. Present the ABN form to your patient and be sure that the patient reads it in its entirety and understands it.
4. Explain why you think the test(s) ordered is medically appropriate.
5. Have your patient personally select Option 1, Option 2 or Option 3.
6. Once the option is selected the patient must sign and date the form.
7. Provide your patient with a copy of the signed ABN and let the patient know that if there are any questions, they can call us or check our website at www.pcnm.com.

Step 3. Submit the completed Advance Beneficiary Notice (ABN) with the completed requisition for those tests that the patient has agreed to receive.

Alert: If the ABN is not properly filled out and/or signed properly by the patient, the processing of the specimen will be delayed or even rejected.