Question MCR Denial for CPT 99497 when billed with G0438 & G0439

[yvonneflintdavis]

When billing G0438 & G0439, it is part of our protocol to review advanced care planning 99497 with our patients. We are documenting the time spent and any changes if necessary. When submitting the claim,we attach modifiered 33 to 99497 and link it to primary dx Z00.00/Z00.01. Medicare is denying the claims stating it is a non-covered charge (PR96) and pushing to patient responisibility. I have attached the MLN for ACP and believe our documentation meets the CMS guidelines. Has anyone come across this issue with CMS? Everything I have read states, the dx code Z00.00/Z00.01 can be link to ACP as long as the 33 modifier is attached.
Any information is appreciated, thanks in advance.

 

[washburncherry@yahoo.com]

When billing G0438 & G0439, it is part of our protocol to review advanced care planning 99497 with our patients. We are documenting the time spent and any changes if necessary. When submitting the claim,we attach modifiered 33 to 99497 and link it to primary dx Z00.00/Z00.01. Medicare is denying the claims stating it is a non-covered charge (PR96) and pushing to patient responisibility. I have attached the MLN for ACP and believe our documentation meets the CMS guidelines. Has anyone come across this issue with CMS? Everything I have read states, the dx code Z00.00/Z00.01 can be link to ACP as long as the 33 modifier is attached.
Any information is appreciated, thanks in advance.

When I code AWV with the 99497 I do not attach the Z00.00/Z00.01 code to it I use Z71.89 advance care discussion with pt and we don't receive denials. Maybe you can try that!