# annual exam



## HBULLOCK (Apr 11, 2012)

I work in a Pedi office but we do have a few patients with Medicare.  I was wondering if I should be using the E/M code (99395) or if i should be using the G code?  There are so many rules specific to Medicare and where I don't code them enough I'm not sure. Anyone who bills these I would appreciate your help. They never paid the physicals before so if i can get paid using the G code I would like to do that. Thanks


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## rradeke (Apr 23, 2012)

Medicare will NOT pay a 99395 it is proper to use the G codes for Annual Wellness Exams and then physician will be reimbursed.


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## Pam Brooks (Apr 24, 2012)

When using the G codes for the Annual Wellness Visit, you have to make sure you meet the documentation guidelines set forth by CMS to get this covered.  Helen, I see you are in Salem.  Here's the link to NHIC's Preventive Care guidelines. 

http://www.medicarenhic.com/ne_prov/publications.shtml

Look under "Education", "Publications", "Preventive Care Billing Guide".


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## berger (Apr 25, 2012)

Of note the AWV is NOT a head to toe physical it is a time for MD to dicuss with patient Prevention.


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## Pam Brooks (Apr 25, 2012)

berger said:


> Of note the AWV is NOT a head to toe physical it is a time for MD to dicuss with patient Prevention.


 

That's correct--it's a risk assessment visit.  Unfortunately, Medicare has called it and "examination" in some of their past patient information, and it caused a lot of confusion last year.


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## HBULLOCK (Apr 26, 2012)

Thanks for the response ladies.  Our exam is not a risk assessment exam its the patients annual physical so to me that means I should continue to use the 99395 code. I will print off the Medicare B guidelines.  Thanks again


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