Prostate exam and yearly physical

rouie

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When I code G0438(preventative) V70.0, with G0102 (prostate exam) V76.44, I am getting a rejection saying G0102 is inclusive. Does everyone get this rejection or am I coding something incorrectly? Please Help!
 

rryder1963

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Prostate exams....

Are not separately payable when a paitent comes in for any other service. If that's the only reason for the appointment, then MCRE will pay for it.

MLN at www.cms.gov has a webbased guide for preventative services that details all the screening services and how to code/bill for them .
 

pineapplelvr

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We only code the G0102 with 99397 etc...the G0438 that you've listed isn't really preventive, it's just a wellness exam which doesn't include any hands on physical exam. Once the provider actually touches the patient (other than vitals) it can become an office visit or preventive.

hope that helps:)
 

nc_coder

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I was having the same issue. I called Medicare. They told me the G0102 is bundled with the separate E/M. If you are billing the AWV, prostate exam, and separate E/M visit, the prostate exam is included in the E/M. If you are billing the AWV and prostate exam only, both should be paid. I have had both paid on the same date when billed as G0438/G0439 and G0102 only.
 

mitchellde

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Also there was a Med Learn Matters on this which stated to bill the G0438/G0439 with the G0102 for the AWV and yearly prostate and both are covered and paid. However it is true if you have any other visit level on the claim then both will not pay, in addition, if your timing is off then they will not pay for both. It is possible that the prostate exam was billed less than a year ago which would make it not covered.
 

nc_coder

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Can I bill the patient?

Also there was a Med Learn Matters on this which stated to bill the G0438/G0439 with the G0102 for the AWV and yearly prostate and both are covered and paid. However it is true if you have any other visit level on the claim then both will not pay, in addition, if your timing is off then they will not pay for both. It is possible that the prostate exam was billed less than a year ago which would make it not covered.
When the G0102 is denied as bundled with the separate E/M , can I bill the patient? Our office has the patient sign an ABN prior to having the prostate exam.
 
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