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

  1. #61

    Question Billing G0438 or G0439 with 93000?

    AAPC: Back to School
    We have been having a debate in the office regarding billing G0438 or G0439 with a 93000 and what modifier is used. Some people are saying 25 on the G code and others are saying 59 on the 93000. Can you help me?

  2. #62
    Join Date
    Apr 2007


    On the CMS website there are booklets that explain these wellness exams
    and Preventive exams. I have printed these to have in case I am asked
    about what Medicare covers and how often.
    It is confusing for the patients, they think they are physicals which they
    are not.
    Hope this is helpful.

    Janice Carr, CPC

  3. #63
    Join Date
    Apr 2007
    Greater Pittsburgh

    Default Annual Wellness for younger Medicare patients

    I am reviewing a visit for a patient who is in their 30's and on Medicare. The provider billed an AWV. They did not document a written screening schedule for the next 5 to 10 years which is required to bill the service. What I cannot wrap my head around is the patient is not a typical Medicare patient based on age. So how would that work as far as to what would be on their checklist? What screenings would be appropriate?

    Any help would be greatly appreciated!

  4. #64


    Wouldn't you just fill out the year they would be due for the screening service?

    For colon cancer screening starting at age 50, you would put the year they turn 50. Anything that doesn't apply, they put "N/A".

    Fill it all out and mail a copy to the patient. You can then bill the AWV.

  5. #65
    Join Date
    Apr 2007

    Question Confused

    1.) Are we allowed to do both the Physical Exam and AWV and bill for both services separately? (Ex: 99397, G0438)

    2.) If we have a patient with Private insurance Primary and Medicare Secondary are we able to do both AWV AND Physical exam and bill the physical Exam (99397) to the private payer and the AWV (G0438) to Medicare?

    All help and thoughts are greatly appreciated!



  6. #66
    Join Date
    Apr 2007
    burlington, iowa

    Question Confused-Medicare Annual coding

    If the physician did not document a AWV... instead he documents a head to toe annual exam for Medicare patient, how would you code this? I know when a breast and pelvic is specified but the physician has done more than a breast and pelvic, you can use the carve out method for 99397 G0101 but what if it does not specify breast and pelvic, but just annual exam ? Do I still use the carve out method and count the physical as breast and pelvic since he did indeed examine the breast and pelvic? It is definitely not a AWV. I just want to make sure I am not missing something here. I have been researching and still do not feel positive enough about it. Thank you!

  7. #67
    Join Date
    Apr 2007


    He must document all the components of the AWV, if he exceeds the criteria that is okay. There is no carve-out for AWV. If he doesn't meet the criteria, you would bill the appropriate CPE.

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