Primary Care Coding Alert
E/M With G0438, G0439 Is Possible, But Tricky
Question: Can we bill an E/M code with a 25 modifier along with annual check-up codes G0438 and G0439?
Answer: Yes, but only if you have thorough documentation that the physician addressed a separate, significant problem that was not preventive in nature.
When the annual wellness visit (AWV) codes were added, CMS noted in the Federal Register that they do not expect to see very many problem services billed on the same date of service as the AWV because of the time involved with performing the AWV. So be sure the E/M problem you’re reporting in addition to the AWV is significant, not minor. For example, during his annual wellness visit, a patient mentions that he has begun experiencing chest pain upon exertion. This statement leads the family physician to ask questions about the history of present illness, perform a review of systems, and do a relevant exam leading medical decision making and a plan for addressing the chest pain. All of that work is consistent with a problem-oriented E/M service and well beyond what is expected with an AWV. Appending 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) denotes the E/M care was separate from the AWV.
Refresher: You have two codes related to annual wellness visits to choose from for your Medicare patients.
You’ll only report G0438 once for each patient – the first time she sees one of your physicians for the service. Each year thereafter, you’ll report G0439.
Florida Subscriber
Primary Care Coding Alert
- CPT® Coding Strategies:
Cue Into Accurate Newborn Exam Reporting With This Guidance
Hint: Use new patient or established codes depending on previous review of the infant. When [...] - Key Elements:
Forgetting to Document PFSH Details Might Cost You More Than $70 Per Encounter
Hint: Omitting history captured in previous visits will mean loss of revenue. When your FP [...] - ICD-10 Update:
Segregate Your Diabetes Mellitus Codes Based on Type
Hint: Use fourth and fifth digit expansion to specify complications. When your FP diagnoses diabetes [...] - You Be the Coder:
Correctly Report Pre-Op Clearance for Surgery
Question: What CPT® code should we submit for pre-op clearance by one of our family [...] - Reader Question:
Let Medical Necessity Drive Your E/M Code Choice
Question: Our physician documents office visits very thoroughly. Because he documents in his EMR so [...] - Reader Question:
E/M With G0438, G0439 Is Possible, But Tricky
Question: Can we bill an E/M code with a 25 modifier along with annual check-up [...] - Reader Question:
Here's When to Report 300.4 Instead of 311 or 300.00
Question: What is the appropriate way to code a claim when the physician calls out [...]
