Medicare Compliance & Reimbursement
Exercise Caution When Reporting E/M Service With AWV Codes
Question: Our FP recently performed an evaluation and management service during an annual wellness visit. Can E/M codes be reported with the wellness visit and if so, is it necessary to use a modifier such as 25 with the annual wellness visit code? The patient is a Medicare patient.
Answer: When your FP performs a Medicare annual wellness visit (AWV), depending on whether or not the patient has had a previous annual wellness visit, you report one of the following codes:
The annual wellness visit is distinct from the initial preventive physical examination (IPPE) (also known as the “Welcome to Medicare” visit) that Medicare also covers. The IPPE is coded using G0402 (Initial preventive physical examination; face-to-face visit, services limited to new beneficiary during the first 12 months of Medicare enrollment). So, if the patient is new to Medicare, you typically report the IPPE code G0402. For the AWV in the following year, you report G0438, and for all the subsequent years, you report G0439.
According to CMS guidelines noted in the Federal Register, they do not expect to see many problem-oriented E/M services billed on the same date of service as the AWV because of the time involved with performing the AWV. However, if your clinician addressed other issues in the same visit as an AWV, you can capture these services with the appropriate E/M visit code.
However, you should take note of Correct Coding Initiative (CCI) edits, because you face bundling when reporting an E/M service code in addition to an AWV or IPPE code. Since the modifier indicator to this code bundle is ‘1,’ you can unbundle the codes with an appropriate modifier.
But, you cannot append the modifier to the AWV HCPCS codes, G0438 or G0439. Instead, you will have to append the modifier 25 (Significant, separately identifiable evaluation and management service by the same physician or other qualified health care professional on the same day of the procedure or other service) to the E/M code to unbundle the codes and allow reimbursement for both the codes.
Medicare Compliance & Reimbursement
- Nursing Facility Visits:
Will Documentation of Your Doctor's SNF Visits Stand Up To Close Scrutiny?
Review of nursing facility care claims data leads to astounding findings. You could find your [...] - Denial Management:
Know Appropriate Use of Modifier 57
Variations in global period definitions spell trouble for you. Use modifier 57 (Decision for surgery) [...] - Modifier 57 Checklist
Use for E/M services only. Use when an E/M service results in a surgery. Make [...] - ICD-10:
CMS Keeps Coding Community on Tenterhooks with ICD-10 Questions
Reps say IPPS and implementation of ICD-10 unrelated. You’re not alone if you have questions [...] - Revenue Booster:
Eliminate Confusion On When To Use Modifiers 52 and 53
You needn’t forego payment for incomplete service. When your surgeon stops a procedure, before you [...] - Reader Question:
Learn When Multi-Provider Visit Could Be Shared Service
Question: My physician and a physician’s assistant visited the same patient in the hospital on the [...] - Reader Question:
Exercise Caution When Reporting E/M Service With AWV Codes
Question: Our FP recently performed an evaluation and management service during an annual wellness visit. Can [...] - 5 Easy Billing Tips for Modifiers 52 and 53
File preparation and clear documentation are the keys to getting these claims paid. When you’re [...] - Industry Notes:
Watch Out For Aggressive OCR Audits This Fall
Keep your eyes peeled this autumn for a notification and data request from the HHS [...]
