Medicare Compliance & Reimbursement

Document your 'Welcome To Medicare' referral.

Your practice may soon be receiving referrals for Medicare's new abdominal aortic aneurysm (AAA) screening service (G0369), which took effect Jan. 1. Will you be ready?

Our experts offer some tips on how to bill this service without worries:

1) Make sure your patient meets the qualifications for this one-time exam, advises Jill Young with Young Medical in East Lansing, MI. To receive coverage, the patients must be "at risk," meaning they either have a family history of AAA or are men aged 65 to 75 who have smoked at least 100 cigarettes.

"The required criteria must be documented in the ultrasound report or be reflected in the patient's medical record," adds Rehna Burge, radiology and cath lab billing analyst for North Oaks Medical Center in Hammond, LA. She advises setting up your scheduling system to check for the criteria before scheduling the patient for the exam.

2) Document the referral. You need to receive a referral from a provider that performed the patient's "Welcome to Medicare" exam, according to the Centers for Medicare & Medicaid Services (CMS). "Only Medicare beneficiaries who receive a referral for the AAA ultrasound screening as part of the Welcome to Medicare physical exam will be covered for the AAA benefit," CMS cautions.

3) Get a signed Advance Beneficiary Notice (ABN) if you can't find out whether your patient actually had the AAA screening before, Burge adds.

4) Include an appropriate diagnosis code. Unfortunately, the National Coverage Determination (NCD) for this procedure didn't include a list of covered ICD-9 codes, Burge laments. She recommends trying V81.2 (other and unspecified cardiovascular conditions) but cautions that other sources may suggest other codes.

5) Don't collect a deductible. The Medicare deductible doesn't apply to this service, although standard copayments do.

6) Make sure that primary care physicians performing the Welcome to Medicare exam know to refer patients at risk for AAA to your practice for this screening exam. Three out of four aortic aneurysms are AAAs, and aortic aneurysms account for about 15,000 deaths in the United States every year, CMS notes. Catching AAAs early can make a huge difference in treating them effectively.

For more information about the AAA screening, read MLN Matters article MM5235 at www.cms.hhs.gov/MLNMattersArticles/downloads/MM5235.pdf.