New Annual Wellness Visit

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My doctor is questioning if codes G0438 and G0439 are to be used in addition with New and Established E/M codes since they do not read as an exam. Thanks in advance!
 

RebeccaWoodward*

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H. Reporting a Medically Necessary E/M Service Furnished During the Same Encounter as an IPPE or AWV

When the physician or qualified NPP, or for AWV the health professional, provides a significant, separately identifiable medically necessary E/M service in addition to the IPPE or an AWV, CPT codes 99201 – 99215 may be reported depending on the clinical appropriateness of the circumstances. CPT Modifier –25 shall be appended to the medically necessary E/M service identifying this service as a significant, separately identifiable service from the IPPE or AWV code reported (HCPCS code G0344 or G0402, whichever applies based on the date the IPPE is performed, or HCPCS code G0438 or G0439 whichever AWV code applies).

NOTE: Some of the components of a medically necessary E/M service (e.g., a portion of history or physical exam portion) may have been part of the IPPE or AWV and should not be included when determining the most appropriate level of E/M service to be billed for the medically necessary, separately identifiable, E/M service.

Begins on page 18...

http://www.cms.gov/Transmittals/downloads/R2109CP.pdf
 

dballard2004

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Thanks Rebecca!

What happens if during the AWV, you perform a complete physicial on the patient similar to the well man physical where there are no complaints? You could report the G code for the AWV for the components of this that you performed, but how would you report the E/M physicial if Medicare does not cover the preventative medicine codes? There are no complaints here.
 

FEU9524

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93000-ekg is it a component for the awv-g0438?

I downloaded the CMS manual that details the differences between the IPPE and AWV, however it doesn't clearly indicate the the EKG is a component of the AWV, G0438. Could someone get back to me on this?

Thanks!
Wendy Lambert, CPC
 
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Wendy,
Medicare will only pay for 1 ekg.
The very first one performed during the initail welcome to medicare visit.
Ekg's are not covered during the AWV's.
If your Dr is going to perform them as part of his/her protocol then they will need to obtain a signed ABN, submit the ekg to medicare for the denial and then bill the patient.
 

nc_coder

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Another question for this subject

I have a physician that performs a prostate exam most times with the AWV. He writes on the encounter form "AWV with prostate exam". I can't charge for the prostate exam or can I? If so, how would I do this?
 

mcubed1205

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We are getting denials from Medicare on the EKG, stating that it is included in the G code for the annual physical. Does anyone have any ideas? I can't find any modifiers that seem to work.
 

rthames052006

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I downloaded the CMS manual that details the differences between the IPPE and AWV, however it doesn't clearly indicate the the EKG is a component of the AWV, G0438. Could someone get back to me on this?

Thanks!
Wendy Lambert, CPC
The correct cpt code you are looking for is G0439, not G0438 that code is for the AWV only.
 

rthames052006

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Thanks Rebecca!

What happens if during the AWV, you perform a complete physicial on the patient similar to the well man physical where there are no complaints? You could report the G code for the AWV for the components of this that you performed, but how would you report the E/M physicial if Medicare does not cover the preventative medicine codes? There are no complaints here.
Hi Dawson:

You would report the E/M physicial as you normally would using the 9938_ - 99397. Regardless if Medicare covers it or not.I'd also have the patient sign a ABN/waiver. If the patient has 2ndary coverage ( I"ve seen a select few pay) bill it to them w/ the EOMB.
 
Last edited:

tmpearce

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What if the EKG was not done as a screening? My Dr. performed a separately identifiable E/M service, did the EKG for HTN and an aortic aneurysm, gave a flu injection and did the G0402. Do I have to bill the EKG as a G0403 just because it was done on the same day, even though it wasn't part of the screening?

Thanks,
Teresa
 
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