Wiki Billing for Physical/V70.0

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angelkat

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I am new to a primary care practice after having worked for a GI office for almost 13 years, to which I have my CGIC. I am not familiar with how to bill for physicals.

The previous biller was using codes 99396 and 99397 with the V70.0 I know this is incorrect as the claims are being denied and the patients are being held reponsible. Can I use the G0438 and G0439 with the V70.0 if it is an iinitial physical and then for those who have subsequent wellness exams?

Also have seen the 2 procedures codes listed above with the pre-op exam code of V72.83, which I know is incorrect as well. I'm pretty sure for the pre-op exams, we can bill either a consult code if requested by the patient's surgeon, or we can bill a regular OV E&M code of 99212-99215 or 99201-99205, along with the diagnosis code for why patient is having surgery. Can someone clarify this for me please....I'm the only biller for this pcp and need some guidance. Thank you, Kathy
 
You must be referring to MCR patients since you are listing the G codes. Medicare does not cover routine physicals, so you are correct in the CPT preventive med codes will not be covered. You are to use the AWV or IPPE HCPCS G-codes and you must meet the criteria.

Search MLN Matters bulletin # MM7079 for further info.

You are correct in the second part of your question regarding the pre-op clearance visits.
 
you are confusing preventive physicals (99387 and 99397) with the Medicare Annual Wellness visits. The Annual Wellness Visits are not teh same as a preventive physical. I suggest that you read the CMS requirement requirements to familiarize yourself with the codes.
 
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