Wiki Coder

[DanJohnston]

My doctor expects me to code a general physical on Medicare patients with a Z0001 (with problems) and a 99215 modifier 25 and a G0439 subsequent physical. Is this allowed by Medicare and Medicare Advantage plans?

 

[CodingKing]

Id have a hard time believing a patient presenting for the AWV would have problems significant enough warranting a 99215.

 

[thomas7331]

My doctor expects me to code a general physical on Medicare patients with a Z0001 (with problems) and a 99215 modifier 25 and a G0439 subsequent physical. Is this allowed by Medicare and Medicare Advantage plans?

Routine/general physicals are not a covered benefit under Medicare. Coding them this way to obtain payment would be incorrect and could be considered fraudulent. 99215 is a problem visit and any history or exam elements used for that code level must be supported by medical necessity of the patient's presenting problems and reason for the visit. G0439 is also not a physical - it is an wellness visit consisting of updates to the patient medical records, risk assessments, plan of care, etc. - the code is not for reporting a physical. Some Medicare Advantage plans, as well as some Medicare supplemental plans, do cover physicals however, and should be reported with the appropriate codes.