Wiki Billing wellness medicare exam plus PQRS?

[Marianelagvs]

I have a question.....how can I billed wellness to medicare exam plus PQRS measures? PQRS can't be billed without a CPT code but the wellness medicare exam is a G code and the 99385, 99395 ect codes are not covered by medicare. What should I do?
Maria G

 

[kenkie79]

I've been billing for well woman visits for a long time and the thing that I was told to do that I am now questioning is to bill the wellness code but to use the GY modifier. You would have to get the patient to sign the ABN and then they will deny it and the balance will go to the secondary insurance who will then pay it (if the patient has a secondary insurance). Otherwise, I was also told to bill the office visit as an office visit (99211,99212,99213,99214, or 99215) with a 25 modifier. I know for sure that they pay it this way as long as you have your DX codes. I don't know, however, if they will pay it if you use the V70.0 or V72.31. I might have to test this theory. Good luck. I hope someone else will answer this.

 

[maddismom]

Maria, what PQRS measure are you trying to report? Some are allowed to be reported with the AWV G codes. If you give me a little more info, I will look up. Each measure has a list of which CPT codes it can and cannot be billed with. I can send you the link if you would like.