Wiki Medicare and the DRE(G0102)

[moricecrys]

Does anyone know what modifier is apporipriate when billing Medicare the annual DRE and OV?

I've billed the E/M with the 25 and 59 on the DRE, and yet they keep denying it.

EX.

99213- dx 401.9
G0102- dx V76.44

Any advise would be helpful! Thanks.

 

[Lisa Bledsoe]

G0102 is bundled into the E/M and not separately billable.

 

[moricecrys]

even with medicare? I was thinking this applies to everyone except Medicare?

With Medicare it is considered a Routine Prevetative exam, once per calendar year?

We bill all other preventative services to medicare and are reimbursed for them

ex.

PSA
Wet Prep
Flu Vaccine
Pelvic Exam
Lipids

etc....

 

[LLovett]

This code is an exam element not a test.

This would be used and paid when a yearly physical is done, the same way you do a pap/pelvic for women. Medicare won't cover the 9939X but they will cover the G0102. You reduce your normal fee for 9939X by the amount of the G0102 and bill them both.

Laura, CPC, CEMC