Wiki Awv

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kathleenl

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Hi,

I have a situation where a patient comes in for her annual GYN visit, it is billed out as G0101 and is denied because she had one a year ago, and is she is not high risk so she should be coming in for her annual once every two years. I am being directed to use G0439 instead. The note is documented as a well woman visit - no complaints, no meds or tests ordered. Basically - all is well. I would prefer to educated the physician on the Medicare guidelines re screening pelvic/pap exams.
I do not think using G0439 is correct. Has anyone else come across this or have any suggestions?

Thank you in advance.

Kathleen
 
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The G0439 is a subsequent annual wellness visit, which doesn't include a pelvic/breast exam (G0101) and has very specific requirements. This shouldn't be completed unless she's had her first AWV (G0438) and unless she was scheduled for an AWV I doubt that all of the requirements were met, so I don't think you should bill for that. Here is a link to the requirements for an AWV: https://www.cms.gov/Outreach-and-Ed...MLNProducts/downloads/AWV_chart_ICN905706.pdf

I hope that helps a little! I've been up to my neck in AWVs lately.
 
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