Wiki annual exam

[HBULLOCK]

I work in a Pedi office but we do have a few patients with Medicare. I was wondering if I should be using the E/M code (99395) or if i should be using the G code? There are so many rules specific to Medicare and where I don't code them enough I'm not sure. Anyone who bills these I would appreciate your help. They never paid the physicals before so if i can get paid using the G code I would like to do that. Thanks

 

[rradeke]

Medicare will NOT pay a 99395 it is proper to use the G codes for Annual Wellness Exams and then physician will be reimbursed.

 

[Pam Warren]

When using the G codes for the Annual Wellness Visit, you have to make sure you meet the documentation guidelines set forth by CMS to get this covered. Helen, I see you are in Salem. Here's the link to NHIC's Preventive Care guidelines.

http://www.medicarenhic.com/ne_prov/publications.shtml

Look under "Education", "Publications", "Preventive Care Billing Guide".

 

[berger]

Of note the AWV is NOT a head to toe physical it is a time for MD to dicuss with patient Prevention.

 

[Pam Warren]

Of note the AWV is NOT a head to toe physical it is a time for MD to dicuss with patient Prevention.

That's correct--it's a risk assessment visit. Unfortunately, Medicare has called it and "examination" in some of their past patient information, and it caused a lot of confusion last year.

 

[HBULLOCK]

Thanks for the response ladies. Our exam is not a risk assessment exam its the patients annual physical so to me that means I should continue to use the 99395 code. I will print off the Medicare B guidelines. Thanks again