Wiki Medicare G0438 and G0444 denial

[mgarcia400]

I work for Family Practice. I billed G0438 for patient as well G0444 for depression screening. I have seen G0444 on the preventative list for Medicare. G0444 was denied for "combination not compatible with another procedure or procedure/modifier provided on same day according to NCCI". Can anyone clarify why the G0444 is denying? G0438 cannot be billed together with G0444? When is it acceptable to bill G0444? Any help is appreciated!

 

[sls314]

I work for Family Practice. I billed G0438 for patient as well G0444 for depression screening. I have seen G0444 on the preventative list for Medicare. G0444 was denied for "combination not compatible with another procedure or procedure/modifier provided on same day according to NCCI". Can anyone clarify why the G0444 is denying? G0438 cannot be billed together with G0444? When is it acceptable to bill G0444? Any help is appreciated!

There is an NCCI edit for G0438 and G0444. G0444 is considered to be a component of G0438.

If you look on the link below from the American Academy of Family Physicians (AAFP), there are bullet points listing the required components to bill G0438. One of those bullet points is: "Review risk factors for depression, including current or past experiences with depression or mood disorders."

https://www.aafp.org/family-physician/practice-and-career/getting-paid/coding/annual-wellness-visits.html

G0444 could be billed in future years with the Annual Wellness Visit (G0439), but not with the Initial Wellness Visit (G0438). There is no NCCI edit for G0444 and G0439 together.

 

[mgarcia400]

There is an NCCI edit for G0438 and G0444. G0444 is considered to be a component of G0438.

If you look on the link below from the American Academy of Family Physicians (AAFP), there are bullet points listing the required components to bill G0438. One of those bullet points is: "Review risk factors for depression, including current or past experiences with depression or mood disorders."

https://www.aafp.org/family-physician/practice-and-career/getting-paid/coding/annual-wellness-visits.html

G0444 could be billed in future years with the Annual Wellness Visit (G0439), but not with the Initial Wellness Visit (G0438). There is no NCCI edit for G0444 and G0439 together.

Thank you! Very helpful!