Pam Warren
True Blue
After reading that some CMS contractors had chosen to hold off on accepting the G0438 until April, I contacted Sue Kimball, CPC from NHIC (the contractor for ME, NH, VT and MA) with a list of questions. Here are her responses, which she has allowed me to share:
Q. I've heard rumors on the AAPC board that we shouldn't be billing the Annual Wellness visit until 4/4 (another contractor, not NHIC). Will you accept G0438 right now?
A. We will accept the G0438 now.
Q. Will you accept an E&M (i.e office visit) if done at the same time as the AWV, with a -25 modifier on the OV?
A. A medically necessary E/M can be billed with the 25 modifier.
Q. What about Pap and Pelvic/Breast done at the same time? Or DRE (G0102)?
A. They can be billed...no modifier necessary.
Q. Also is the V70.0 appropriate? If not, what meets the medical necessity guidelines?
A. V70.0 is appropriate. We look for no specific diagnosis.
Just an FYI. For providers that already submitted these codes, we denied as routine. We updated our system on January 11, 2011. Any denials will be reopened by us.
Q. I've heard rumors on the AAPC board that we shouldn't be billing the Annual Wellness visit until 4/4 (another contractor, not NHIC). Will you accept G0438 right now?
A. We will accept the G0438 now.
Q. Will you accept an E&M (i.e office visit) if done at the same time as the AWV, with a -25 modifier on the OV?
A. A medically necessary E/M can be billed with the 25 modifier.
Q. What about Pap and Pelvic/Breast done at the same time? Or DRE (G0102)?
A. They can be billed...no modifier necessary.
Q. Also is the V70.0 appropriate? If not, what meets the medical necessity guidelines?
A. V70.0 is appropriate. We look for no specific diagnosis.
Just an FYI. For providers that already submitted these codes, we denied as routine. We updated our system on January 11, 2011. Any denials will be reopened by us.
