Wiki Medicare annual

[vjensenbfp]

We have a patient scheduled for an annual Medicare px (not a preop px) G0438 but he is having surgery with another provider prior to our physical appointment so the physical will be within the global period of the sx.

His surgery will have a global period. Will be get paid for the G0438 since I can't put a 24 modifier on the G code? If they sign an ABN won't the patient be responsible if Medicare denies the G0439.
I know Medicare won't accept a mod 25 on the G code so I am assuming they won't accept a mod 24 either.

 

[vjensenbfp]

whoops the annual px is G0439 not G0438 .. typo

 

[thomas7331]

The global surgical period a different physician would not apply to your claim unless the two providers happen to be of the same specialty and work for the same group. Even so, G0439 should not require a modifier as it is not a service that is ever a component of a global surgical package. An ABN is not appropriate here - an ABN is for a situation where coverage criteria may not be met, usually due to medical necessity, but where the patient chooses to have the service anyway. It does not allow providers to bill patients for services that are denied for other reasons.

Incidentally, G0439 is not the correct code for an annual physical exam - G0438 & G0439 are wellness visits with different documentation criteria from a physical, and do not include an exam. If the provider is performing an annual physical, a code from the 99381-99397 range should be billed - this would be denied as a non-covered service and can be billed to the patient or the secondary payer. Since it is statutorily excluded from Medicare coverage, an ABN is not necessary.