# Medicare Depression Screen G0444



## Leixm@southwesthealth.org

When are we to bill the Depression Screen, G0444, and what documentation do we need to support this code? The providers here generally do a 2 question depression screen--I wouldn't think that would be sufficient to bill this. However, I have looked at a few things that state you don't bill the G0444 when treatment is given. I'm confused, any help would be greatly appreciated!


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## mitchellde

It is a screening for depression only.  It will not include any treatment as it is just screening to determine if the patient has depression. The CMS bulletin for this stated:
The provider must have in place staff-assisted depression care supports who can advise the physician of screening results and who can facilitate and coordinate referrals to mental health treatment. HCPCS Level II code is G0444 Annual depression screening, 15 minutes.
At a minimum level, staff-assisted depression care supports consist of clinical staff (e.g., nurse, Physician Assistant) in the primary care office who can advise the physician of screening results and who can facilitate and coordinate referrals to mental health treatment. 
More comprehensive care supports include a case manager working with the primary care physician; planned collaborative care between the primary care provider and mental health clinicians; patient education and support for patient self management; plus attention to patient preferences regarding counseling, medications, and referral to mental health professionals with or without continuing involvement by the patient’s primary care physician.
Note: Coverage is limited to screening services and does not include treatment options for depression or any diseases, complications, or chronic conditions resulting from depression, nor does it address therapeutic interventions such as pharmacotherapy, combination therapy (counseling and
medications), or other interventions for depression. Self-help materials, telephone calls, and web-based counseling are not separately reimbursable by Medicare and are not part of this NCD.
Screening for depression is non-covered when performed more than one time in a 12-month period. Eleven full months must elapse following the month in which the last annual depression screening took place. Medicare coinsurance and Part B deductible are waived for this preventive service.


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## Colliemom

Debra - 

We are also wondering if this will be covered, it was billed with the following codes:
G0438
99213-25
81002
93000
G0444

The G0444 is being denied, but looking at the CMS website, I think it should be covered. We are being told we should bill with the GZ modifier, does this sound correct?  Or is the G0444 bundled into the G0438?


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## mitchellde

It should not bundle into the G0438, also what dx code did you link to the G0444.  The other concern is the 99213, do you have the documentation to support each of these separate components, that is the G0438, 99213 and the G0444?  In some regions Medicare will not pay the preventives when coupled with a visit level.


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## lori mitchell

Hi. My understanding is that the depression screening is bundled with the IPPE or  the initial AWV, so G0444 would not be separately reportable with G0438.


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## cynthiabrown

I think depression screening is bundled


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## Cortzea

*Wellness Visit*

All screening's are bundled into the wellness visit. ( FALL RISK, Depression) I would suggest you revise the requirements for a wellness visits. Based on my experience most wellness visits are NOT done correctly.


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## EZielinski

*Depression Screen*

G0444 is NOT able to be billed with G0402 (IPPE), but it can be billed with G0438 and G0439 as part of the the annual wellness visit.  It cannot be performed with the IPPE, as it is a part of the IPPE and cannot be billed separately.  You must perform the PHQ-9 not the PHQ-2 in order to bill the code.  What's 7 more questions really? It will be covered and not applied to the patients deductible when performed during the annual wellness visit.


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## TARRA

*G0444 and G0439*

EZielinski, are you getting reimbursed for G0444 when billed with G0439 or G0438....are you using any kind of modifier on any of the codes?  I cannot get Medicare to pay the G0444!


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## jaimepl63

*Billing MGR*

We can not get any screenings (G0444 or G0442) paid when they are performed with a wellness exam (G0438 or G0439).  We have tried different diagnosis as well.  We tried Z13.89 Encounter for screening for other disorders and Z00.00 adult physicals.

Has anyone got ever received payment from Medicare?  If so please explain.


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## StacyGalloway

Colliemom said:


> Debra -
> 
> We are also wondering if this will be covered, it was billed with the following codes:
> G0438
> 99213-25
> 81002
> 93000
> G0444
> 
> The G0444 is being denied, but looking at the CMS website, I think it should be covered. We are being told we should bill with the GZ modifier, does this sound correct?  Or is the G0444 bundled into the G0438?



Per the AAFP you can only bill the G0444 with G0439.  Also see the CMS link for items included with the AWV.  IF the example above was G0439, then you would append the G0444 with a 59.  We are being reimbursed with this.  What we are running into is the ACP being bundled with other procedures done the same day (G0101, 96372, Q0091 to name a few).  This requires Modifier 59,33 on the 99497 code to un-bundle.  

Hope this helps.
Stacy, CFPC

http://www.aafp.org/fpm/2014/0100/p25.html
https://www.cms.gov/Outreach-and-Ed...MLNProducts/Downloads/AWV_Chart_ICN905706.pdf


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## susie09

Can the clinical staff provide the PHQ 9 questionnaire  and would this count towards the 15min time base or does the provider have use the 15min strictly in counseling


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## EZielinski

TARRA said:


> EZielinski, are you getting reimbursed for G0444 when billed with G0439 or G0438....are you using any kind of modifier on any of the codes?  I cannot get Medicare to pay the G0444!



The G0444 is being paid by Medicare.  We are being reimbursed for it.  It should be done with the annual wellness visit.  I apologize it is not reimbursed with the G0402 or G0438, only the G0439.  The Depression screening is bundled and included in the charges for G0402 and G0438.  You can bill and will be reimbursed for the G0444 if you have completed the PHQ-9 and 15 minutes spent (generally most coders will tell you that you need at least 8 minutes in order to bill for 15) If the patient takes 5 minutes to complete the form, and the MA has to enter the information in the EMR, that can be almost 10 minutes right there.  Then the discussion with the patient should put you at the time needed for the screening.  We put a 59 modifier on the G0444.  We have been reimbursed for 3 years without incident.


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## danskangel313

I don't understand why you'd want to bill all of these codes for one DOS.

G0438
99213-25
81002
93000
G0444

G0438 can never be billed with G0444 under any circumstance. But why tack on the G0444 when it's already included in G0438 to begin with?

When I checked these:
99213
81002
93000
I got no edits.

99213
81002
93000
G0444 
G0444 bundles with 99213, however a modifier is allowed if appropriate. But I'm not sure why you'd want to throw in a depression screening where it doesn't seem to fit. Not to mention the fact that the depression screening would have to be independent from all other services. To me, it seems like a waste of a yearly depression screening when considered with the amount of work to get it paid. If there was concern for depression, it could be addressed in the office visit charge and that'd save G0444 for another time.

99213
81002
93000
G0438
99213 bundles with G0438 but a modifier is allowed if appropriate.

Billing all of those charges mentioned, no matter what, G0444 will never get paid, ever. And now it's been used up so you have to wait another year to get it done again.

Here's my point of view on these situations. There's nothing in the rulebook that says you HAVE to have an AWE or G0444 EVERY year. Once you use one up, then you gotta wait another year before you can do it again. If you have no medical issues that need to be addressed, then use your AWE. So long as the code is G0439, then you can also do G0444. If you DO have a medical issue that you'd like evaluated, then don't waste your AWE as the visit should be coded using an office visit charge. Anytime a actual medical condition is addressed, an office visit charge would be the more accurate code in most cases.

Preventive services for Medicare don't have to be as complicated as they seem. Keeping in mind that although a service is available to you, you don't HAVE to use it, especially if you don't need to. There are no OOP expenses for these services, so why not keep them around for a time where you may actually need them. And if all else fails, you could just smash the services at the end of year (the annual ones).


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## CodingKing

Is there any information stating that the PHQ2 is insufficient for billing G0444. I have a doc that wants to bill G0444 on every patient (Medicare, Medicaid, Commercial etc) even if they answer No to the 2 questions.


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## rcanales

*G0444 vs 99420*

Hello everyone, 

When patients have commercial insurance are you billing 99420 for the PHQ DEPRESSION SCREENING OR just reporting 3725F? I am confused for the commercial payers.


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## emmieg1@yahoo.com

*emmieg1*



jaimepl63 said:


> We can not get any screenings (G0444 or G0442) paid when they are performed with a wellness exam (G0438 or G0439).  We have tried different diagnosis as well.  We tried Z13.89 Encounter for screening for other disorders and Z00.00 adult physicals.
> 
> Has anyone got ever received payment from Medicare?  If so please explain.



Hello Everyone, we use mod 59 to G0444 and it gets paid. hope this helps.


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## Cortzea

*IPPE elements*

IPPE or Welcome to Medicare has certain "elements " that need to be met , see below :

*At a minimum*

● Past medical/surgical history (experiences with illnesses, hospital stays, operations, allergies,
injuries, and treatments)

● Current medications and supplements (including calcium and vitamins)- UPDATE all med - must indicate if the meds were reconciled 

● Family history (review of medical events in the beneficiary’s family, including diseases that may
be hereditary or place the beneficiary at risk)

● History of alcohol, tobacco, and illicit drug use ( does pt use alcohol -list how often ) ( tabacco current smoker , how many and what does the pt smoke ) and list yes or no for any illicit drug use or any of the previous questions.

● Diet ( does the pt fallow a low sodium diet, BRAT diet, low glycemic diet , puree etc )

● Physical activities ( does the pt walk , does any exercises .. ) 

 obtain current or past experiences with depression ( YOU ONLY GET REIMBURSE FOR G0444 when is done with the Welcome to medicare)  or other mood disorders, use any appropriate screening instrument for beneficiaries without a current diagnosis of depression from various
available standardized screening tests recognized by national professional medical organizations

Please keep in  mind that the SCREENING needs to be perform for patients that do  not have an active diagnosis of Depression or any mood disorders - G0444 is the code to be used and the screening tool can be the PHQ-2 or PHQ-9 , the provider needs to document the tool administered. Depression screening is only reimbursed during the Welcome to medicare or IPPE 

Use appropriate screening questions or standardized questionnaires recognized by national
professional medical organizations to review, at a minimum, the following areas:

● Activities of daily living ( does the pt need help with showering, eating, walking ( list any DME's ) , document who provides the help and how often)

● Fall risk ( has the pt fallen in the last year ? How many times ? how did the pt fall ( slipped , tripped , loss balance , dizziness due to meds or condition) there is an assessment available from the CDC called "STAY INDEPENDENT" or STEADI

● Hearing impairment ( is the pt hard of hearing ? , does the pt use hearing aids , document referrals to specialist )

● Home safety ( does the pt live alone, fire alarm, CO2 monitor , life support button- provide information, family support  ) 

Obtain the following:

● Height, weight, body mass index, and blood pressure

● Visual acuity screen ( if pt uses glasses or have any diagnosis of eye disease list when was the last eye exam and who follows the pt )

● Other factors deemed appropriate based on the beneficiary’s medical and social history and
current clinical standards ( THIS IS VERY IMPORTANT - SPECIALLY when you have pt's with Chronic conditions and comorbitities )
          for Diabetic pts please list /order any blood work needed for DM pt's , who is the endo specialist , does the pt have any complications of DM, has 
          the pt seen a renal specialist , neurologist , eye doctor , FOOT doctor 
          If a patient has heart conditions and HTN ( review your guidelines for 2017) there is now an assumed "casual relationship" between HTN and 
          heart failure ( CAT I50. )
          For pt's that suffer CKD -stage must be listed and last GFR and document whether or not the pt is on dialysis 
          Osteoporosis - when was the last DEXA test , is the pt under medications , who follows this DX ? 
          Pain management - 

End-of-life planning is verbal or written information provided to the beneficiary about: VERY IMPORTANT - EVEN IF THE PT REFUSES OR DOESNT HAVE ANYBODY IN MIND TO CARRY HIS/HER WISHES PROVIDER NEEDS TO DOCUMENT THAT THE INFO WAS PROVIDED . IF PT DOES HAVE AN ADVANCE DIRECTIVE try to obtain a copy ( document if pt refused to provide doc but at least document the name of the person or whether or not pt would like life support ) 

● The beneficiary’s ability to prepare an advance directive in case an injury or illness causes the
beneficiary to be unable to make health care decisions

● Whether or not you are willing to follow the beneficiary’s wishes as expressed in an
advance directive

Based on the results of the review and evaluation services in the previous components, provide
education, counseling, and referral as appropriate
      does the pt need obesity consultation ( specially for Diabetic- this is benefit that sometimes is cover for medicare pt's )
      Smoking consult ( you get reimbursed for this ) 
      Depression referral 
       Pain management referral for chronic pain ( new guidelines indicate PCP's cannot longer prescribe pain meds for more than 14 days i think - same 
       for medications that treat anxiety , depression since they are considered highly addictive and puts pt's at a higher risk for falls )  

Includes a brief written plan, such as a checklist, for the beneficiary to obtain:
● A once-in-a-lifetime screening electrocardiogram (EKG/ECG), as appropriate ( there is a preventive code for pt's that do not have a diagnosis that warrants an EKG and is covered once during a life time G0403 - use this under the IPPE and the pt comes any other time you can code a regular EKG with SS 
● The appropriate screenings and other preventive services that Medicare covers



Based on my experience and the fact that i helped revamp the wellness visit in my previous office i came to the conclusion that performing an IPPE and a AWV is a very complex process , there are a lot of "elements " to follow and Document in order to be compliant with CMS , most practices dont even give their pt's a health risk assessment or provide a summary of the screenings needed or simply a summary of the visit , but be certain that is not impossible to accomplish !!


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## Charanjit07

*Medicare depression screen*



Leixm@southwesthealth.org said:


> When are we to bill the Depression Screen, G0444, and what documentation do we need to support this code? The providers here generally do a 2 question depression screen--I wouldn't think that would be sufficient to bill this. However, I have looked at a few things that state you don't bill the G0444 when treatment is given. I'm confused, any help would be greatly appreciated!





lori mitchell said:


> Hi. My understanding is that the depression screening is bundled with the IPPE or  the initial AWV, so G0444 would not be separately reportable with G0438.


 hi - as per me - it seems that G0444 is used for depression screening whose have some components of annual visit- G0439/G0438 so it will be denied due to it has bundling relationship we can use the modifier 59 to get paid.


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## redtnc

Depression screen is part of the Annual Wellness, Initial and Subsequent visits.  It can not be billed separtely.  I found this in AAPF, it has been very helpful and we have been reimbursed.

*Q*
What is the appropriate CPT code to report screening for depression?

*A*
Use code 96127, “Brief emotional/behavioral assessment (e.g., depression inventory, attention-deficit/hyperactivity disorder scale), with scoring and documentation, per standardized instrument.” However, for Medicare patients who are receiving screening in the absence of symptoms (i.e., as a preventive service), use code G0444. Code G0444 may be reported for an annual depression screening up to 15 minutes using any standardized instrument (e.g., PHQ-9) in a primary care setting with clinical staff who can advise the physician of screening results and who can facilitate and coordinate referrals to mental health treatment as necessary. When signs or symptoms lead you to provide a brief emotional/behavioral assessment for a Medicare patient, 96127 is the appropriate code. *Depression screening should not be separately reported when provided as part of the initial preventive physical examination* (“Welcome to Medicare” physical) *or initial annual wellness visit.* Code Z13.89, encounter for screening for other disorder, is the ICD-10 code for depression screening.

I hope this helps.


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