If I were to hazard a guess, if you find that G0439's are being denied it is due to the patient not previously having had a G0438.
Originally Posted by email@example.com
There are 3 Medicare wellness visits:
G0402 - Welcome to Medicare. Patient is eligible for the first year after Medicare Part B kicks in. This is the only code that will be accepted by Medicare during the first year and has specific guidelines that need to be met, notably, end of life planning, which is not required in the next two codes.
G0438 - Annual Wellness Visit, Initial. If the patient is beyond their first year of Medicare eligibility and has not previously had a Annual Wellness Visit, then this is the proper code, regardless of how long the patient has been eligible for Medicare.
G0439 - Annual Wellness Visit, Subsequent. This is only appropriate if the patient has previously had a G0438. Of note, G0438 & G0439 are new benefits as of 2011, therefore it is impossible to have billed G0439 during 2011 (though a number of my providers tried--and some even got paid ).
It is important to stress this is not a CPE. We have found that many patients have come in for their "Medicare physical" and the provider does a regular physical, which is not covered. We end up eating the charge because the front end staff didn't clearly ascertain that the patient was here for an Annual Wellness Visit. Because of the specific requirements of the Annual Wellness Visit (depression screen, safety screen, cognitive check, etc.) 99.9% of the time a CPE cannot be recoded as an AWV.
L. Mark Kozu, COC, CPC, CCC