Wiki G0438 and G0439 HELP

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casey.meyer24@gmail.com

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Ok I am relatively new to billing. I know that a G0402 needs to be done within 12 months of Medicare enrollment, and I know that a G0438 needs to be done 1 year after that, then G0439 every year after. Here is my question: I have a whole bunch of encounters where I need to crosswalk preventative checkup codes to G-codes, and the encounter has all the proper documentation for a G0439, but there is a problem: We never billed out a G0402 or G0438 and it is long past the one year mark after enrollment (or they had Medicare before coming into our health system). Can I still bill out a G0439 if we never billed out a G0402 or G0438?
 
Jo-Anne Sheehan, CPC, CPB, CPC-I, CPPM, COC

Medicare covers only one Initial Annual wellness visit per patient per lifetime: (G0438) If you missed the IPPE G0402, then bill the G0438.
CPT G0439 Subsequent Annual Wellness Visit is to be used in the subsequent years after the submission of G0438 (Initial annual wellness visit).

Note: If the patient shifts from one physician to another physician code G0439 (Subsequent annual wellness visit) if you know the other physician already billed a G0438. However, you may have to go onto the Medicare website to see what benefits have previously been billed out. You always need to bill the G0438 prior to the G0439. The question is, did another physician bill the G0438 first?
 
In many instances, no the physician never billed out the G0438. Can this be billed out even if the patient enrolled in Medicare more than two years ago? Also, how do you check which benefits have been billed out on the website (for patients whom joined our health system years after MC enrollment)?
 
I agree with Jo-Anne's statement above.

Yes, even if the G0438 has never been billed and it's outside of the 2 year time frame from when they enrolled in Medicare, the G0438 will still need to be billed before they will allow the G0439

Renee Billinger, RHIT, CPC
 
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