Wiki Need help with G codes and code 96160

[michelle0710]

We sent a claim to medicare with the following codes and paid on a few but G0444, 96160 and G0008, I called Medicare as was told to add a Modifier on all three. Can someone help me on what I need to do. Also with code 96160, can this code be billed with other codes or strictly by itself? Can 96160 and a G code be billed together? New at billing G codes, Appreciate any help, thanks,
G0439 pd
99214 Mod 25 pd
G0444
96160
90662 pd
G0008
90471 pd

 

[rthomas@impcna.com]

We sent a claim to medicare with the following codes and paid on a few but G0444, 96160 and G0008, I called Medicare as was told to add a Modifier on all three. Can someone help me on what I need to do. Also with code 96160, can this code be billed with other codes or strictly by itself? Can 96160 and a G code be billed together? New at billing G codes, Appreciate any help, thanks,
G0439 pd
99214 Mod 25 pd
G0444
96160
90662 pd
G0008
90471 pd

For Medicare patient's you should only bill G0444 for a depression screen. You cant bill both G0444 & 96160. I am surprised that 90471 was paid because G0008 is the correct administration code that should be billed with a flu vaccine. If we bill 90471 with a flu vaccine instead of G0008 it gets denied. The way we would bill this to Medicare is as follows:
G0439
99214 25
G0444 XU
90662
G0008

 

[michelle0710]

Thank you rthomas for the above. This really helps. Can you help me understand code 96160. I have a claim with 96127 & 96160, 96127 paid and not 96160, why? I know 96160 can not be billed by itself it has to have an E/M code attached to it, right? what are the other ways a 96160 can be billed. Appreciate your help.

 

[rthomas@impcna.com]

Thank you rthomas for the above. This really helps. Can you help me understand code 96160. I have a claim with 96127 & 96160, 96127 paid and not 96160, why? I know 96160 can not be billed by itself it has to have an E/M code attached to it, right? what are the other ways a 96160 can be billed. Appreciate your help.

I am not sure what type of practice you are in but I am in an Internal Medicine and Pediatric practice. In my experience many payers consider 96127 & 96160 to both be depression screenings. The way we utilize these codes are as follows:
96160 we use for depression (PHQ-9) screening during wellness exams with dx Z13.31
96127 we use for ADD/ADHD (Vanderbilt) assessment/follow up with dx F90.0 - F90.2

 

[Maureen77]

We sent a claim to medicare with the following codes: G0438, 93000, G0444 & 96160. Medicare only PD us G0438 denied G0444, 93000 These procedures or procedure/modifier combination is not compatible with another procedure, should I pended mod 59?

 

[sls314]

We sent a claim to medicare with the following codes: G0438, 93000, G0444 & 96160. Medicare only PD us G0438 denied G0444, 93000 These procedures or procedure/modifier combination is not compatible with another procedure, should I pended mod 59?

G0438 already includes the depression screening as a required element. You can't unbundle and bill separately for the G0444.

That's why G0438 has a CCI conflict with G0444, and a modifier is not allowed to override the relationship.

Was the EKG a screening or diagnostic/medically necessary? Medicare only covers a screening EKG during the one-time "Welcome to Medicare" preventative visit.

 

[Maureen77]

Thanks for the fast response, I noticed for G0444 per medicare guidelines no modifier is allowed when is billed in conjunction with G0438, now EKG was done as diagnostic and link to the Hypertension

 

[sls314]

Thanks for the fast response, I noticed for G0444 per medicare guidelines no modifier is allowed when is billed in conjunction with G0438, now EKG was done as diagnostic and link to the Hypertension

The modifier 59 will work for a diagnostic EKG. There is a CCI edit between G0438 and 93000, but a modifier is allowed to override the relationship when applicable.

 

[andreajac]

G0438 already includes the depression screening as a required element. You can't unbundle and bill separately for the G0444.

That's why G0438 has a CCI conflict with G0444, and a modifier is not allowed to override the relationship.

Was the EKG a screening or diagnostic/medically necessary? Medicare only covers a screening EKG during the one-time "Welcome to Medicare" preventative visit.

Can psychiatric clinicians such as psychiatrists and NP's bill 96160 with an EM code (99202-05 and 99212-15)? If so how often can this be billed commercially? I'm asking because clinicians in our psychiatry practice are getting push back for 96127 and not getting paid at all for them. THey generally do PHq9 and other screenings sometimes at every visit to track progress. Not sure what codes will best capture the additional work if 96127 is being denied. They do have 96160 on their fee schedules but we've never used and I'm unsure if we should and also how often. TIA