billing for annual exams

[t.b.townsend09@gmail.com]

hi,

question I know you can't bill for the 99396,99386 series for Medicare patients does this mean you also can't bill the ICD-10 Z00.00-Z00.01?

thanks in advance for your help

 

[thomas7331]

It's not true that you can't billed these codes for Medicare patients. You can bill them (and you should bill them if those codes represent what is documented), but Medicare does not cover them, so the patient or their secondary insurance will be responsible for the payment.

 

[t.b.townsend09@gmail.com]

It's not true that you can't billed these codes for Medicare patients. You can bill them (and you should bill them if those codes represent what is documented), but Medicare does not cover them, so the patient or their secondary insurance will be responsible for the payment.

ok, what about the Dx?

 

[thomas7331]

ok, what about the Dx?

I was referring to both CPT and Dx codes. In all cases you should bill the codes that best represent the services and diagnoses that are documented for the encounter.

 

[lgardner]

hi,

question I know you can't bill for the 99396,99386 series for Medicare patients does this mean you also can't bill the ICD-10 Z00.00-Z00.01?

thanks in advance for your help

Medicare will pay for an AWV that is billed with dx codes Z00.00 or Z00.01, but they will not pay for the preventive visit CPT codes.

Also, I agree with Thomas that you should bill for whatever service is performed, regardless of whether it gets paid or not.
At our practice, we do not schedule Medicare patients for preventive visits.

 

[OpenClaims]

hi,

question I know you can't bill for the 99396,99386 series for Medicare patients does this mean you also can't bill the ICD-10 Z00.00-Z00.01?

thanks in advance for your help

Keep in mind that you must code from documentation. So, if the provider is documenting that they did a CPE, you will code and bill a CPE even though Medicare does not pay for it. It would be the office's responsibility to ensure that the patient knows that the CPE is non-covered. If your provider is documenting an AWV or IPPE, make sure that they've met ALL criteria for those visits in order to code them. Z00.00 and Z00.01 are the correct primary codes for each of these.