Q. From a PARC reader: We have a question after reading the "Administering the new HINNs" article in the June PARC newsletter. Can you give examples of items or services for which we should give a HINN 11? We had a situation recently where a patient asked for her monthly osteoporosis medication. She was an inpatient at the time, but the medication was not related to her stay. Her request was out of convenience.

Would this be a situation where a HINN 11 would be appropriate? 

A. Judith L. Kares, JD, CPC, HCPro, Inc.: In answer to your question, HINN 11 is only appropriate to notify a beneficiary of his/her liability for noncovered severable services when all of the following criteria are met:

• The item or service is excluded from coverage as medically unnecessary (under a written Medicare policy)

• The beneficiary requires a continued inpatient stay

• The inpatient stay is covered under Part A

• The item or service is not bundled or integral to payment or treatment for the diagnoses or reasons justifying the inpatient stay.

Here is an example that I use when teaching the HCPro Medicare Boot Camp--Hospital Version course that illustrates when use of the HINN 11 would be appropriate: A patient admitted as an inpatient is being treated for pneumococcal pneumonia (481) with pneumonitis due to toxoplasmosis (130.4).

During the otherwise Part A covered stay, the physician orders a PET scan for breast cancer which does not meet Medicare’s medical necessity guidelines. The PET scan is not bundled into or integral to payment or treatment for the diagnoses/reasons justifying the covered inpatient stay.

In that case, the hospital may notify the patient (and the attending physician), using HINN 11, referencing NCD PET (FDG) for Breast Cancer, 220.6.10. If you have a question as to whether to use HINN 11 for particular services ordered in the inpatient setting, I recommend that you check with your FI or MAC. In particular, the hospital must reference a written Medicare policy to support the hospital's position that the particular item or service is excluded from coverage as medically unnecessary.

Good luck as you apply these rules.