Wiki Coders: Annual Wellness Visit--Read the Guidelines!!

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medicare icd9 for laboratory preventive screening

need your help! what icd9 do you all use for routine laboratory screening for Medicare recipients and even when you have no clue as to what the patient may have medically?
 
@ Doug--There is a preventive care guide (check CMS) that identifies the tests and approved diagnosis codes allowed for coverage by Medicare. But Medicare does not cover most routine screenings. V72.62 is the code for lab work done as part of a routine visit, but this will not be covered by Medicare. For this population, you are better off to determine whether or not the provider is ordering a surveillance lab to monitor a patient's chronic conditions, than you are to assume it's routine. If you "don't have a clue", I'd advise you to query the physician to get one, or you'll be getting phone calls from angry patients.

@espressoguy---sure, you can use that however you wish.
 
I work for a family practice also and they are asking me about billing G0444 (screening depression) along with the AWV. I read the guidelines and screening for depression is already being Done within the AWV. Is anyone billing G0444 Along with the AWV??? Too me it seems like unbundling :confused:
 
Pam Brooks said:
Here is the Patient Information FAQs that we use. It's a combination of information from CMS, and info from our practices. Use what you need.
Click to expand...

Thank you Pam. This Q & A is much simpler to explain to our MDs and Site Sups than some of the straight CMS docs. I plan on using this in my educational sessions, if you don't mind.
 
I am looking for some assistance in regards to doing a preventative with g0442 and g0444. If we do a preventative can we still bill for both the the alchol screening and depression screening at the same time. We have done a 99396 with a 25 modifier and then a G0442 with no modifier and then a g0444 with a 59 modifier on the same claim. BCBS will pay the 99396 and the g0442 but not the g0444, saying that the modifier that they don't like the modifier that has been used. We also have done it with no modifier on the g0444 and they are still using the same denial code of not liking the modifier. Any help that you can give us would be greatly apprecitated.
Chris Milewski
Lawn Medical Center
lawnmedical@comcast.net
 
You don't need the modifier 59. G0442 and G0444 do not have any CCI conflicts. Not sure why you were using it, but I would get rid of it and you'll probably get paid.
 
Medicare physicals and initial/subsequent

:confused:
So I am very confused on all of these services. We are having our software people (clearly not coders) telling us we cannot bill these G0402, G0438 and G0439 visits unless the patient is 65 or older. When researching on CMS (in Iowa we are now under Noridian) I can't seem to make heads or tails of any of this information. I did print out Pam Brooks PDF she provided. Can someone help straighten this out for me? My question is this- if we have Medicare insured women coming to the clinic for a pap smear and physical, for example, how would you code this. This is just an easy quick example I'm providing to see where I'm missing the boat if I am!

Thanks

Erin, CFPC
 
Billing G0438 or G0439 with 93000?

We have been having a debate in the office regarding billing G0438 or G0439 with a 93000 and what modifier is used. Some people are saying 25 on the G code and others are saying 59 on the 93000. Can you help me?
 
On the CMS website there are booklets that explain these wellness exams
and Preventive exams. I have printed these to have in case I am asked
about what Medicare covers and how often.
It is confusing for the patients, they think they are physicals which they
are not.
Hope this is helpful.

Janice Carr, CPC
 
Annual Wellness for younger Medicare patients

I am reviewing a visit for a patient who is in their 30's and on Medicare. The provider billed an AWV. They did not document a written screening schedule for the next 5 to 10 years which is required to bill the service. What I cannot wrap my head around is the patient is not a typical Medicare patient based on age. So how would that work as far as to what would be on their checklist? What screenings would be appropriate?

Any help would be greatly appreciated!
Joyce
 
Wouldn't you just fill out the year they would be due for the screening service?

For colon cancer screening starting at age 50, you would put the year they turn 50. Anything that doesn't apply, they put "N/A".

Fill it all out and mail a copy to the patient. You can then bill the AWV.
 
Confused

1.) Are we allowed to do both the Physical Exam and AWV and bill for both services separately? (Ex: 99397, G0438)

2.) If we have a patient with Private insurance Primary and Medicare Secondary are we able to do both AWV AND Physical exam and bill the physical Exam (99397) to the private payer and the AWV (G0438) to Medicare?

All help and thoughts are greatly appreciated!

Thanks,

Marisela
 
Confused-Medicare Annual coding

If the physician did not document a AWV... instead he documents a head to toe annual exam for Medicare patient, how would you code this? I know when a breast and pelvic is specified but the physician has done more than a breast and pelvic, you can use the carve out method for 99397 G0101 but what if it does not specify breast and pelvic, but just annual exam ? Do I still use the carve out method and count the physical as breast and pelvic since he did indeed examine the breast and pelvic? It is definitely not a AWV. I just want to make sure I am not missing something here. I have been researching and still do not feel positive enough about it. Thank you!
 
He must document all the components of the AWV, if he exceeds the criteria that is okay. There is no carve-out for AWV. If he doesn't meet the criteria, you would bill the appropriate CPE.
 
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