Wiki WELCOME TO MEDICARE G0402

mesafam6

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Is The G0402 welcome to medicare considered a complete physical ? does that include medication refills such as depression, diabetes, ordering labs etc.. or does it require billing a seperate E&M CODE 99213-25 in addition to the G0402? Can we bill the AWE WITH AN E&M AND A PHYSICAL ? G0402,G0438, G0439 W/ 99213-99214 AND 99397(MEDICARE ADVANTAGE PLANS) ?
 
Hi Mesafam6:)
The CPT G0402 is billed for Medicare pts AWE but if the patient has a new problem during same time as AWE visit doc can address this with a CPT 99212-99214. So say the patient get regular chronic conditions checked, meds, vitals, Etc. Now fell & hurt ankle the day before AWE physical or has bad rash on his hand . The doc can add CPT 99213 , do xray for ankle in office and maybe a pain injection which can be added to the same claim as the G0402 .Ensure link proper dx to each CPT code. If injection or vaccination or lab test done add modifier 25 too. If none of these things done but Medicare pt. has new problem add proper Eval/mgnt code and the G0402
I hope this helps..we use to do this family practice in Ohio when I worked there
Well I hope I helped you
Lady T🙂
 
Is The G0402 welcome to medicare considered a complete physical ? does that include medication refills such as depression, diabetes, ordering labs etc.. or does it require billing a seperate E&M CODE 99213-25 in addition to the G0402? Can we bill the AWE WITH AN E&M AND A PHYSICAL ? G0402,G0438, G0439 W/ 99213-99214 AND 99397(MEDICARE ADVANTAGE PLANS) ?
Here are some helpful links with information I have gotten from CMS and our MAC:

 
I wonder if anyone has a link to an article or can point me in the direction to find out about when it's appropriate to bill an office visit along with the physical or annual wellness exam? I work in family practice and our providers do it all the time, but sometimes I feel like the extra visit isn't justified and would like to find something in print explaining when it's okay to do it, to educate myself and my providers.
 
, Documentation is the key. If the provider documents active conditions addressed and treated other than required by CMS for Welcome to Medicare visit then the level of e/m the documentation supports as medically necessary should pass the test
 
Let's say a patient comes in for their physical (or Medicare AWV), has hypertension and high cholesterol that they're on medication for and they're completely stable, no changes made, do you think it's justifiable to charge the extra office visit in that particular case? Part of me says yes, they're on medication and they would have to come in for a visit to get meds renewed, but part of me says no, part of a physical is checking blood pressure and cholesterol anyway so it's not doing anything above and beyond what would normally be done. We get so many patients calling and complaining about that extra office visit, even though we have a form explaining it at the front desk which they sign when they come in stating it COULD happen.
 
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