CG MODIFIER for RHC

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40
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Farmington, MO
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My question is when is this appropriate and when is it not to use the New CG modifier for a RHC? If I am understanding this correctly the CG would be attached to only the preventive HCPC codes and preventive 99406 and 99407 (codes G0436 and G0437 are no longer existent for tobacco sensation). There seems to be conflicting information on this issue. please review example below.

99213-25 // EM Service
G0438-CG //Initial visit Wellness

and if only a Wellness was done then would this be billed as.....

G0438-CG

??????

Thank you for time in reviewing,
we have a conflict in interest here regarding the new guidelines concerning this issue and understanding when it is and when it is not appropriate :p
 
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40
Location
Farmington, MO
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The CG and Facility

I code for both sides the facility and E/M and it has been brought to my attention that the CG modifier is not for surgery codes either IN or Out Pt. and only applies to Medicare. If there is a preventive service or a preventive with a E/m service for Physician office based setting than the CG is applied to Preventive when it is the primary reason for the visit only on the preventive. The E/M code would still get a 25 modifier however in this scenario it does not matter in what order the codes are billed.

If I am understanding correctly this only pertains to RHC clinics not Facility charges. I set examples below:

Pt. came for there annual subsequent Medicare wellness exam but during the visit they also stated they have a sinus infection:

Codes reflected in either order in this fashion
G0439 -CG or 99213 -25
99213 -25 or G0439 -CG

However if patient came to the office for any other reasons other then the above scenario the attach the CG modifier to the first line on the claim. Please keep in mind when billing additional charges the E/M service will need a CG,25 CG should come before the 25 since it reflects as a direct payment modifier.
 

Dfreddie

Networker
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Beach, North Dakota
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The link I read, it looked like it only applied to certain codes, and the 99212-99215 was not part of that list. So, I'm confused as well. When I looked, I couldn't find much information on it.
 
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