Wiki Annual Wellness Visits w E&M

[Marija Gobov Vukelja]

I need help.
I am reviewing AWV claims and often see that providers put same DX codes in Dx pointer for E&M and G0439 codes

Example:

diagnoses:
A. I252, B.Z951 C. N18.3 D. E11.22
E. D500 F. e11.40 FZ68.27 ...

D. E. Diagnosis pointer
99215 - 25 ABCD
G0439 ABCD


Does Medicare pay for claims like that?
thanks

 

[mitchellde]

I need help.
I am reviewing AWV claims and often see that providers put same DX codes in Dx pointer for E&M and G0439 codes

Example:

diagnoses:
A. I252, B.Z951 C. N18.3 D. E11.22
E. D500 F. e11.40 FZ68.27 ...

D. E. Diagnosis pointer
99215 - 25 ABCD
G0439 ABCD


Does Medicare pay for claims like that?
thanks

I would need to see the note for an accurate assessment. However billing a level 5 visit for a patient that is also well does not seem likely. If this is an annual wellness then you use the Z00 code first listed. If there are no abnormal issues then it is a wellness encounter only. The Z00 codes are first listed only.

 

[Marija Gobov Vukelja]

I get confused when they put same diagnoses next to G0439 in Dx pointer and next to E&M code since E/M service is significant and separately identifiable from the AWV.
shouldn't they put Z00.00 for AVW and for other issues ABCD next to E&M code?

 

[mitchellde]

If the documentation does support medical necessity for a significant and separate encounter for abnormal findings, PLUS the separate documentation for the AWV, then yes. I have never found that the documentation does support both. But you must look at the Z00 parameters.

 

[Revenuecycle]

Does anyone know if billing for the G0402 in a provider based clinic...can the hospital bill the TC side of that with a nursing visit? We bill the dx as the Z00.00 for both.

For example:
G0402 professional fees?
G0463 Technical fees?