Primary Care Coding Alert

New bundles for G0438 and G0439 shouldn't hit your bottom line.

The latest updates from the Correct Coding Initiative (CCI) went into effect Oct. 1, with more pairings affecting the new annual wellness visit (AWV) codes G0438 (Annual wellness visit; includes a personalized prevention plan of service [PPS], initial visit) and G0439 (Annual wellness visit, includes a personalized prevention plan of service [PPS], subsequent visit).

Edits bundle both G0438 and G0439 into G0402 (Initial preventive physical examination; face-to-face visit, services limited to new beneficiary during the first 12 months of Medicare enrollment). CCI classifies the edits as mutually exclusive with a modifier indicator of "0," which means you cannot append a modifier to override the edit and report both codes.

Good news: As most practices are aware, you shouldn't report an AWV during the same encounter as the "Welcome to Medicare" exam represented by G0402 (also called an IPPE for "initial preventive physical examination"). The latest edits confirm what coders know through common sense and shouldn't affect your bottom line.

CCI version 17.3 offers 1,380 new edit pairs and 835 terminated bundles, according to an analysis by Frank Cohen, MPA, MBB, principal and senior analyst with The Frank Cohen Group, LLC. As was the case with the previous CCI edition, the majority of edits impact the codes from the musculoskeletal code range (20000-29999), but bundles did occur to codes throughout the CPT® manual.

For more on CCI edits and to find which ones impact your practice, visit the CMS Web site at www.cms.gov/nationalcorrectcodinited/ncciep/list.asp.