# G codes vs CPT codes



## CMW (Jan 20, 2015)

Sooo Confused...Any advice is appreciated in advance!!

I code for a small family practice, we have not been offering the IPPE and AW (G codes) visits to our patients. ( we are not contracted with Noridian Medicare and our Dr's do not want to do the paperwork...lazy) 

However, they have recently changed their minds and want to start providing this service to our patients. Few questions!!

1. Are the G codes only used when billing Noridian Medicare or do we use them with MedAdvantage plans? I have been billing out the 99397-99387 to our MedAdv plans and we have been getting paid but does the G code indicate we did the necessary paperwork? 

2. I have researched and get contradicting information. When billing the G codes we can also bill a E/M? My understanding in the E/M can be billed with modifier 25 if an ACUTE issue was treated. So does that mean cough/fever/dog bit ect. or would we be able to bill out an E/M with a G code with dx of exisiting conditions such as hyperlipidemia, depression, A-fib, diabetes ect.?

last question.....

3. How is the easiest way to keep track of what G code is appropriate to bill? What if the pt was seen else where for the initial, how is the best way to know that? Just trying to prevent a bunch of corrected claim do to denials!!

Again thank you for your time!!!

CMW


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## xistinalequeenofhearts@gmail.com  (Jan 22, 2015)

When I am uncertain about billing a G code I look it up on the specific insurances fee schedule, if it's not there you will know not to use it. If you can't find the fee schedule through google I am sure a quick call to a rep will prove helpful.


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## bonn715 (Jan 24, 2015)

you can bill a separate E/M  with the Medicare Wellness Visits, and you do need the 25 modifier on the E/M you bill with it.  
Some Medicare verification websites do show what preventative services they have had already, if i rem right MyMedicareData.com does.  
The replacements that offer preventative benefits will generally pay on the regular CP codes, it is best to check with the payor or follow the way they are processing to see what is accepted

good luck to you


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## CMW (Jan 27, 2015)

Great ideas...Thank you both!!!


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