# When to code G0438



## Faith@032413 (Jan 15, 2018)

Hi All, 

Good Afternoon,

I have a doubt in G0438, when to code G0438 whether it is age base criteria example(only applicable for 99387) or for all cpt's (998381 - 99387). Any one please clarify doubt.


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## CodingKing (Jan 15, 2018)

It is for use for a Medicare annual wellness visit. Its not the same thing as an age appropriate physical exam.


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## Faith@032413 (Jan 15, 2018)

CodingKing said:


> It is for use for a Medicare annual wellness visit. Its not the same thing as an age appropriate physical exam.



Hi,

My question is can we code G0438 for age (younger than 1 year, age 1 through 4 years, age 12 through 17 years, 18-39 years, 40-64 years).

It is purely medicare code applicable for  65 years and older. Here there is no doubt. Clarify above mentioned statement.


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## CodingKing (Jan 16, 2018)

G0438 should be used for Medicare patients only. It's not restricted by any age. They just have to be on Medicare.


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## Faith@032413 (Jan 22, 2018)

Thank you, I have understood.


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## AmyZCPC (Feb 15, 2018)

*G0438 what diagnosis is used?*

I have been getting Medicare edits stating that Services may not be covered with Principal DX  of Z00.00.   Anyone with the same issues?  

Any input you have to offer would be helpful!


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## brandi.stvns (Feb 19, 2018)

*G0438*

I have had conflicting answers on this.  

One group, UHC Medicare Complete, the G0438 or G0439 is billed with any chronic conditions, i.e. diabetes, HTN, first.  followed by any screening tests that are being ordered (i.e. colon cancer screening, mammogram, DEXA).  We are having success, AKA getting paid , using this format.  Humana, however, only seems to pay the G0438 or G0439 if we use the screening tests first, then additional codes for chronic conditions.  It was recommended by both parties to bill the age related code with a 25 modifier and Z00.00 as the diagnosis. 

Those are the two insurances that we deal with the most for Medicare Advantage.  Not sure what Medicare recommends you use for a diagnosis code.  

Hope that helps....


Brandi S., CPC


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## MaribelChavez (May 3, 2018)

Has anyone heard of a Regence MedAdvantage patient getting an annual wellness visit (G0439) and an Annual Physical in the same year? If so, what code would you use for the additional physical? Regence is saying that their members are eligible for both and are both covered at 100%. I'm very confused about this. I asked if 99397 would be covered and the rep said that code was not coming up in their system as a valid cpt code.


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