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Coders: Annual Wellness Visit--Read the Guidelines!!

  1. Default medicare icd9 for laboratory preventive screening
    Exam Training Packages
    need your help! what icd9 do you all use for routine laboratory screening for Medicare recipients and even when you have no clue as to what the patient may have medically?

  2. #52
    Dover Seacoast New Hampshire
    @ Doug--There is a preventive care guide (check CMS) that identifies the tests and approved diagnosis codes allowed for coverage by Medicare. But Medicare does not cover most routine screenings. V72.62 is the code for lab work done as part of a routine visit, but this will not be covered by Medicare. For this population, you are better off to determine whether or not the provider is ordering a surveillance lab to monitor a patient's chronic conditions, than you are to assume it's routine. If you "don't have a clue", I'd advise you to query the physician to get one, or you'll be getting phone calls from angry patients.

    @espressoguy---sure, you can use that however you wish.
    Pam Brooks, MHA, COC, PCS, CPC, AAPC Fellow
    Coding Manager
    Wentworth-Douglass Hospital
    Dover, NH 03820

    If you can dream it, you can do it. Walt Disney

  3. Question
    I work for a family practice also and they are asking me about billing G0444 (screening depression) along with the AWV. I read the guidelines and screening for depression is already being Done within the AWV. Is anyone billing G0444 Along with the AWV??? Too me it seems like unbundling

  4. #54
    Ellenville, New York
    Quote Originally Posted by Pam Brooks View Post
    Here is the Patient Information FAQs that we use. It's a combination of information from CMS, and info from our practices. Use what you need.
    Thank you Pam. This Q & A is much simpler to explain to our MDs and Site Sups than some of the straight CMS docs. I plan on using this in my educational sessions, if you don't mind.


    Director, Health Information Management
    HealthAlliance of the Hudson Valley
    Kingston, NY

    2016 Secretary
    Ellenville, NY Local Chapter

  5. #55
    Default New to coding!
    Hi Pam,

    Could you please share a copy of your FAQ and checklist:
    My email address is
    Thank you .

  6. #56
    Dover Seacoast New Hampshire
    It's posted within this thread.
    Pam Brooks, MHA, COC, PCS, CPC, AAPC Fellow
    Coding Manager
    Wentworth-Douglass Hospital
    Dover, NH 03820

    If you can dream it, you can do it. Walt Disney

  7. Default
    I am looking for some assistance in regards to doing a preventative with g0442 and g0444. If we do a preventative can we still bill for both the the alchol screening and depression screening at the same time. We have done a 99396 with a 25 modifier and then a G0442 with no modifier and then a g0444 with a 59 modifier on the same claim. BCBS will pay the 99396 and the g0442 but not the g0444, saying that the modifier that they don't like the modifier that has been used. We also have done it with no modifier on the g0444 and they are still using the same denial code of not liking the modifier. Any help that you can give us would be greatly apprecitated.
    Chris Milewski
    Lawn Medical Center

  8. Default
    You don't need the modifier 59. G0442 and G0444 do not have any CCI conflicts. Not sure why you were using it, but I would get rid of it and you'll probably get paid.

  9. Default Thank you!
    I needed to read this! It helped a LOT!!

  10. #60
    Default Medicare physicals and initial/subsequent

    So I am very confused on all of these services. We are having our software people (clearly not coders) telling us we cannot bill these G0402, G0438 and G0439 visits unless the patient is 65 or older. When researching on CMS (in Iowa we are now under Noridian) I can't seem to make heads or tails of any of this information. I did print out Pam Brooks PDF she provided. Can someone help straighten this out for me? My question is this- if we have Medicare insured women coming to the clinic for a pap smear and physical, for example, how would you code this. This is just an easy quick example I'm providing to see where I'm missing the boat if I am!


    Erin, CFPC

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