AWV, Breast & Pelvic & E/M

nperry

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My doctor is trying to bill for G0438, Annual Wellness Visit with G0101 & Q0091, the Breast/Pelvic with Pap along with a 99213. I know the AWV & Breast & Pelvic can be billed together but can all 3 be charged by the same doctor at the same visit?? Thanks
 

ollielooya

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Everett, WA
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It is my understanding that in order to bill for the EM visit you cannot use a combined ROS, vitals, etc for both AWV and EM visit. The requirements can't be counted twice even if they are documented one time, so you might want to check out the Level Three office visit and make sure it meets the level three criteria. Downcoding may be a real possibility. Hopefully, others will check in to correct, clarify or to confirm.
 

Pam Brooks

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Local Chapter Officer
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South Berwick, ME
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Because HPI/ROS/PFSH cannot be "double dipped" with regard to the 99213 and AWV, we chose not to allow our physicians to bill the E&M with the AWV....also patients understand that the AWV is "FREE" and when they get a bill for the deductible/co-insurance associated with the 99213, they flip out on our billers! So we avoid all that and our docs ask the patient to come back to address the chronic conditions, or they just document it as part of the AWV but don't bill it out (their choice).
 
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