G0444 denial

[ymajestic04@gmail.com]

I am a biller in a family practice clinic and recently we are getting denials for G0444 with modifier 59 and diagnosis code Z71.89. It seems that the diagnosis code is "invalid per NCCI edits". We do many Medicare Annual Wellness Visits and have always used this diagnosis for G0444 and 99497. Does anyone have any insight on why this is now being denied and the proper diagnosis code to use for this? Any help would be appreciated.

 

[sls314]

I am a biller in a family practice clinic and recently we are getting denials for G0444 with modifier 59 and diagnosis code Z71.89. It seems that the diagnosis code is "invalid per NCCI edits". We do many Medicare Annual Wellness Visits and have always used this diagnosis for G0444 and 99497. Does anyone have any insight on why this is now being denied and the proper diagnosis code to use for this? Any help would be appreciated.

What other CPT/HCPC codes are on the claim? Is this an initial or subsequent AWV?

NCCI edits aren't about diagnosis codes. One of your CPT or HCPC codes is hitting an edit against another.

The Initial AWV (G0438) has a depression screening as a component. G0444 is not separately billable with it, and no modifier will override it.

If you're billing G0438, then that's your NCCI edit. You'd need to remove G0444 from the claim.

diagnosis codes, diagnosis coding

 

[ymajestic04@gmail.com]

What other CPT/HCPC codes are on the claim? Is this an initial or subsequent AWV?

NCCI edits aren't about diagnosis codes. One of your CPT or HCPC codes is hitting an edit against another.

The Initial AWV (G0438) has a depression screening as a component. G0444 is not separately billable with it, and no modifier will override it.

If you're billing G0438, then that's your NCCI edit. You'd need to remove G0444 from the claim.

CPT codes are G0439, G0444-25, 99497-33, 99321-25 and G2211. Are you saying we can't bill a G0439 (AWV) and G0444 (depression screening) on the same superbill? Is this a new?

diagnosis codes, diagnosis coding

 

[iimc701]

99321 is a deleted code. G2211 is only an add on code to E/M office visit codes. G0444 shouldn't have a 25 modifier on it.

diagnosis codes, diagnosis coding

 

[ymajestic04@gmail.com]

99321 is a deleted code. G2211 is only an add on code to E/M office visit codes. G0444 shouldn't have a 25 modifier on it.

You are correct. Should read G0439, G0444-59, 99497-33, 99213-25 and G2211.

diagnosis codes, diagnosis coding

 

[sls314]

CPT codes are G0439, G0444-25, 99497-33, 99321-25 and G2211. Are you saying we can't bill a G0439 (AWV) and G0444 (depression screening) on the same superbill? Is this a new?

No, I said you can't bill G0444 with the Initial AWV (G0438). You also can't bill G0444 with the IPPE (the "Welcome to Medicare" exam).

Both the Initial AWV and the IPPE already have depression screening as a required component, so you can't unbundle and bill the depression screening separately with a G0444.

G0439 is the Subsequent AWV. The depression screening is not a required component of that, so if performed it can be billed separately with the G0444.

You can see the list of required components for the Medicare Wellness Visits and billing/coding guidance on the CMS website at this link: https://www.cms.gov/medicare/covera...edicare-wellness-visits/annual-wellness-visit

diagnosis codes, diagnosis coding