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Primary Care Coding Alert

Reader Question:

Only Use E/M With G0438 for Separate Problem

Published on Mon Nov 05, 2012

Question: One of our providers completed her first annual wellness visit for a patient. Most of the patients think this is a physical, but we know it is different. This is the first wellness check for the patient. Do I bill 9921x and G0438, or do we submit one code or the other, but not both? Mississippi Subscriber Answer: Assuming that the wellness visit is the only service rendered, you should report only the wellness code, G0438 (Annual wellness visit; includes a personalized prevention plan of service [PPS], initial visit). E/M explanation: You should only include an E/M code if your provider needs to treat the patient for a specific diagnosis during the visit and performs and documents the work associated with a problem-oriented E/M service. For example, the patient schedules a wellness exam and presents with an illness, which the provider treats during the course of the encounter, in [...]
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