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New Annual Wellness Visit

  1. #1
    Default New Annual Wellness Visit
    Medical Coding Books
    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!
    K. Patrician, CPC

  2. #2
    Location
    North Carolina
    Posts
    3,126
    Default
    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

  3. #3
    Location
    Overland Park, KS
    Posts
    1,166
    Default
    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.
    Dawson Ballard, Jr., CPC, CEMC, CPMA, CCS-P, CPC-P, CRHC, AAPC Fellow
    Coder

  4. #4
    Default
    That's what I was looking for on page 13 under number 4. Thank you very much.
    K. Patrician, CPC

  5. Exclamation 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

  6. #6
    Default
    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.

  7. Default 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?

  8. #8
    Location
    Tampa, Florida
    Posts
    14
    Default
    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.

  9. Default
    CCI has bundled the 93000 into G0438 and G0439 as of 7/1/2011

  10. #10
    Location
    Tampa, Florida
    Posts
    14
    Default
    Thank you. I appreciate the info.

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