Part B Insider (Multispecialty) Coding Alert

Published on Fri Jul 14, 2006 PDF

Perform traditional procedures, but don't code them that way

You know that patients who are new to Medicare qualify for a one-time head-to-toe screening physical exam and screening ECG within six months of enrollment. But are you sharp on how to reap optimal reimbursement with the right G codes?

New codes: For this kind of screening visit, instead of flipping to a traditional ECG code such as 93000 (Electrocardiogram, routine ECG with at least 12 leads; with interpretation and report), you-ll need to use one of the new G codes:

- G0366--Electrocardiogram, routine ECG with at least 12 leads; with interpretation and report, performed as a component of the initial preventive physical examination

- G0367--Tracing only, without interpretation and report, performed as a component of the initial preventive physical examination

- G0368--Interpretation and report only, performed as a component of the initial preventive physical examination

Hint: The G codes are identical to some traditional codes, so if you-re having trouble deciding which to use for the Welcome to Medicare procedures, try this:

- If you would usually use 93000, use G0366 instead.
- If you would usually use 93005, use G0367 instead.
- If you would usually use 93010, use G0368 instead.

Example: A physician or qualified nonphysician who performs the complete ECG service, in addition to the physical, would report both G0344 (Initial preventive physical examination; face-to-face visit, services limited to new beneficiary during the first six months of Medicare enrollment) and G0366, according to the Nov. 15, 2004 Federal Register.

Take note: Medicare won't pay for G0366 and G0367 when the physician performs the services in the facility setting, the Register said. The reason is that these two codes include the technical component of the test. In a facility setting, you should not report the technical component of the service, just the professional component (G0368).