Wiki G0439

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abrodskycpc

Networker
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Aurora, Illinois
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Hi,

I am new to using this code. I know that it can only be billed to Medicare once every 12 months. So what do you do if a provider tries to bill it before that 12 month period. Do you charge an E/M?

TIA!
 
At this point, billing an E/M is about your only option since Medicare will deny the AWV since it has not been 12 months. There is a caveat with this though and that is that the E/M could be subject to a deductible or co-pay. When that patient came in, they thought they were going to get an AW and not owe anything due to that. Really weigh your options since you don't want to send a bill to a patient that came in for a free service.
 
If a patient is coming in for an AWV before 12 months have past, G0439 will get denied. Although various information is provided about how to bill particularly regarding ABNs, I found a CMS document, although it's from 2012, that might help: https://www.cms.gov/outreach-and-education/outreach/npc/downloads/ippe-awv-faqs.pdf

"Is an Advanced Beneficiary Notice required for non-covered services?
The Advanced Beneficiary Notice (ABN) is not required for services that are statutorily excluded from coverage, such as preventive exams. Practitioners should alert beneficiaries to financial liabilities and the voluntary ABN is one way of doing so."

All visits need a medically necessary reason for the encounter. If you're going to bill for the service, I'd be careful in picking out an E/M charge if there is no CC. And as previously mentioned, the patient could be subject to deductibles or coinsurances, so you'd need to make sure they are aware of that prior to the visit. Although an ABN is not REQUIRED, I'd still get one for the reason mentioned above.
 
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