Wiki Annual Exam G0439 vs 99201-99205

[tracylc10]

I am fairly new and I have some questions about coding a medicare annual exam. When do you know that you have to use a HCPCS code? I am working for an OB/Gyn office and have questions about yearly exams. I know that Medicare does not cover the preventive visits every year, only every 2 years. We had a new 70 yr old pt come in for her Annual Exam and she had already had one last year with another provider. My physicians want to code this with an office visit E&M code, 99201-99205. I have been researching this and I almost think that it should not be coded as such and that they should code it G0439. They did order a mammo as well, but did not do a pap.

Any insight on this would be greatly appreciated. Thank you.
Tracy

 

[mitchellde]

Annual well woman is coded with the G0101 and the Q009 and is covered once every two years. The G0439 is a yearly wellness visit and is covered every year. If this is the off year well woman then use the preventive E&M code as it will be patient responsibility.

 

[tracylc10]

Thank you. I have been reading on this and am I to understand that G0439 is not an annual physical, but just a wellness visit with no exam? Also, on the off year when coding a preventive E&M, would you have the pt sign an ABN to make them aware that Medicare will not pay and that they will be responsible for the bill?

They really don't make this easy do they?

Thank you again for your help.

 

[ValerieBatesHoffCPCCPMA]

Annual Wellness Visit (AWV) - page 2.

PREVENTIVE SERVICES CHART​

ICN 006559 October 2015
This educational tool provides the following information on Medicare preventive services: Healthcare Common Procedure
Coding System (HCPCS)/Current Procedural Terminology (CPT) codes; coverage requirements; frequency requirements;
and beneficiary liability for each Medicare preventive service.
Please note: The information in this publication applies only to the Medicare Fee-For-Service Program (also known as
Original Medicare). For additional guidance on the use of diagnoses codes, go to Pub. 100-04 Claims Processing
Manual, Chapter 18.v


https://www.cms.gov/Medicare/Preven...wnloads/MPS-QuickReferenceChart-1TextOnly.pdf