Wiki Modifiers for G0439, 99215 and 99498

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angelalhale

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I am a new coder and having trouble with denials for our ACP with the G0439 the same day as 99215. I have added the MODIFIER 25 to the 99215 and MODIFIER 33 to the 99498 and I get CO-236: This procedure or procedure/modifier combination is not compatible with another procedure or procedure/modifier combination that was provided on the same day. I could use some help on this thanks to anyone who knows what I do.
 
99498 shouldn't be used without first using 99497.

99497 is for the first 30 minutes, 99498 is each additional 30 minutes.
 
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angelalhale said:
I am a new coder and having trouble with denials for our ACP with the G0439 the same day as 99215. I have added the MODIFIER 25 to the 99215 and MODIFIER 33 to the 99498 and I get CO-236: This procedure or procedure/modifier combination is not compatible with another procedure or procedure/modifier combination that was provided on the same day. I could use some help on this thanks to anyone who knows what I do.
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Hi there, 99215 is bundled into G0349 and I assume that's what's triggering the error. If appropriate you can use a modifier to report the E/M visit.

CMS allows you report the ACP visit on the same day as the AWV/IPPE Report the ACP code with modifier 33. See p. 4. www.cms.gov/outreach-and-education/medicare-learning-network-mln/mlnproducts/downloads/advancecareplanning.pdf

Report the primary ACP code, as sls314 said, and make sure you only use the time for the ACP service when you calculate time.
 
you must carve out the dx codes for each to have them seperated. i.e. 99215 extended ov for chronic conditions, hypertension, diabetes - whatever they filled meds for and G0439 sub awv for wellness, screenings, bmi etc and yes the 25 goes on the 99215.
 
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