Wiki Billing E/M with G0447 for obesity

[mrf4d]

Hi, I have a provider who is seeing patients strictly for obesity, that is the only condition covered during the visit. For example, patient presented to discuss being prescribed a GLP-1 like Zepbound. For Medicare patients, the provider is billing for an E/M visit, usually CPT 99213 and G0447. The criteria is met for G0447, as far as time and 5 A's documented, but I don't think it's appropriate to bill both an E/M and G0447 for the same condition. It feels like double dipping. There's guidance in CPT and Codify that state CPT 99401/99402 are separate procedures that shouldn't be billed with an office visit, but I can't find any guidelines from Medicare addressing this. I have checked MLN matters, NCD, everywhere I know. Can someone please help?

 

[AC]

It is considered double dipping. You shouldn't bill G0447 if one of the primary reasons for the E/M is obesity, and especially not if obesity is the only reason for the E/M. That service would be included in the E/M service even if separate time is documented. Try the CMS NCCI Edit Manual, Chapter 11 or 12. There may be some helpful info there that you can use as a resource. There is also a PtP Edit on these codes being billed together and G0447 is included in 99213 unless 99213 is performed for a totally different, unrelated condition.