Coding both G0439 and 9939- to Medicare during the same year

dpavao

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We are having an issue with one of our primary care practices. There is a new provider who is part of an IPA and they state that they bill out to Medicare an Annual Wellness Visit under G0438/G0439 with medical diagnosis codes and then at another time during the year the same patient comes in for their Preventative Annual and they bill 9939- using the Z00.00 and that they get paid for both visits.
I have never heard of this and am not sure if this is something that can be done.
Does anyone have any insight into this type of situation?
Thank you in advance.
 

jhendrix08

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Yes, if these patients are covered under Medicare Advantage plans you can do that and you will be reimbursed. We typically try to space out the Medicare Wellness (G0438/G0439) and their Annual Preventive (9939-) at about 6 months apart or so. Any diagnosis code(s) can be used for the Medicare Wellness exam, and yes the Z00.00 code should be used as the primary code for the annual preventive visit.

For both these types of visits, the requirement is that they are done every calendar year (doesn't matter what month or day). Again, this is only for the HMO Advantage Plans not straight Medicare.

Hope that helps.
 

JR

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Albany NY
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Mcr advantage plans Annual & preventative @ same visit

I was wondering can an annual (G code) & preventative 9993 be done at the same visit? Thanks!
 

jhendrix08

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Are you referring to the Annual Wellness (G0438/G0439) and a regular annual physical? If so, we don't schedule/bill these on the same day. For our Medicare Advantage patients, we typically try to schedule these visits 6 months apart.

Hope that's helpful.
 
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