Part B Insider (Multispecialty) Coding Alert

Published on Fri May 17, 2013 PDF

Rural health clinics may have been shortchanged since January.

Have your preventive visit payments been dwindling over the last few months? CMS has taken notice—and is trying to remedy the problem.

At issue: The January 2013 quarterly release include an error that shorted rural health clinics for annual wellness visits (AWVs) and initial preventive physical exams (IPPEs) that they reported, CMS stated in a May 16 news blast.

"Until system changes can be implemented, rural health clinics should follow the billing instructions outlined below to ensure there is no further delay in your Medicare payments," the agency advised. Those steps are as follows:

Submit AWV services to your MAC with either G0438 or G0439 and revenue code 052X and "ensure no other services are reported on the claim with the same line item date of service as the AWV," CMS notes.

Submit IPPE services on a separate claim to your MAC. So if you report an encounter on the same date as an IPPE, "submit the first claim with revenue code 052X and no HCPCS/CPT code," CMS advises. "The second claim should be submitted with revenue code 052X and HCPCS code G0402."

Payers that were holding these claims waiting for a system fix will soon begin returning these claims to practices, but you’ll have to resubmit them using the guidelines above.