Wiki 99213, G0439 & 99397

[ACollison]

Hello

I have a provider trying to bill for 99213, G0439 & 99397. I feel like these should bump up against each other ?


99213-25 DX H40.023, M05.79, R80.9 & L89.309
G0439-25 DX E11.628 & E11.29
99397-25 DX Z01.419
99497 DX Z71.89
G0444 DX Z13.31
93000 DX Z13.6
99173 DX Z01.419

 

[chantal777]

Hello

I have a provider trying to bill for 99213, G0439 & 99397. I feel like these should bump up against each other ?


99213-25 DX H40.023, M05.79, R80.9 & L89.309
G0439-25 DX E11.628 & E11.29
99397-25 DX Z01.419
99497 DX Z71.89
G0444 DX Z13.31
93000 DX Z13.6
99173 DX Z01.419

I know you can bill an AWV G0438,G0439 with an EM service 99213 however, I am not sure if 99397 can be billed with AWV and an EM. please see the table

 

[njycarter17]

Traditional Medicare insurance will not cover 99397, but any Medicare Replacement plans will cover 99397 as long as documentation supports 99397. No modifiers are allowed for the AWV (G0402, G0439, or G0438). We do bill this frequently for our primary care clinics. We always append modifier 33 to 99497 when done same visit as AWV as no co-payment, coinsurance, or deductible that will apply as long as ACP is provided same day as AWV. 93000 is not covered as screening, but anytime EKG is done for IPPE (G0402) you can bill G0403 (EKG) that is covered only once per lifetime with dx Z13.6. Usually Medicare does not cover 99173 with a screening dx, you did have Z01.419 (routine annual gynecological exam). If patient had pelvic/pap annual exam you would bill G0101 and Q0091.

G0439 DX: Z00.00
99397 - XU DX: Z00.00
99213 - 25 DX: H40.023, M05.79, R80.9 & L89.309
99497 - 33 DX: Z71.89
G0444 - XU DX: Z13.31
93000 - XU DX: Z13.6
99173 - XU DX: Z01.00

FYI:
Patients with Humana Medicare insurance we bill 96160 as long as documentation supports code - payer does reimburse for this patient-focused health risk assessment.
Our providers also will do a fecal-occult blood test (G0328-QW DX: z12.11) during AWV.


Hope this helps some - We do a lot of Medicare AWV =)