Practice Management Alert

Question: We have several AWV charges (G0438) that have been denied because we attached a modifier 25 because an injection was given during that same visit. Normally we attach the modifier 25 to office visit. Are we billing this incorrectly?Maryland SubscriberAnswer: Medicare will deny the annual wellness visit (AWV) you're billing with G0438 (Annual wellness visit; includes a personalized prevention plan of service [PPS], first visit) if you attach modifier 25 (Significant, separately identifiable evaluation and management service by the same physician on the same day of the procedure or other service). There reason is that G0438 and other G codes are not problem-oriented E/M services to which that modifier applies as defined under the modifier 25 usage rules.You should just bill the injection separately.Remember: The purpose of the AWV is to provide a preventive planning service, not take care of problems the patient has at the same time. "The [...]