Wiki Coding a Medicare Wellness Exam & Complete Physical Together

[jeaner54175@yahoo.com]

I'm hoping someone can answer this because I am finding conflicting information in other post or on-line and there is a debate in our office with providers on how to do this. If a patient comes in for their Annual Medicare Exam (G0439) and request a physical as well how would you code both exams? Would you code it as G0439 with an E/M code plus modifier 25 or G0439 with an age preventive visit code with modifier 25?

Thank you,
Lisa

 

[kroemer4]

AWV with Additional Services

Considering the AWV is Medicare's response to non-coverage of preventive visits, if a patient presents and expects a "touchy" exam during the "no touchy" AWV, best practice would be to ensure the patient understands that a portion of the day's services are not covered by Medicare and are not ABN eligible and would then fall to the patient at full cost. Only then would it be acceptable to bill the preventive code based on age and ensuring all elements are met after extracting the AWV documentation. If the patient has acute problems addressed in the visit, it would be acceptable to bill a 99201-99215 based on the documentation elements after the AWV criteria is extracted from the note. The patient would be responsible for any established copays for the acute visit. In both of these scenarios, the -25 modifier would be appended to the E/M code.