Wiki CPT code confusion - Medicare

[toots9798@hotmail.com]

Hello, I am in desperate need of guidance. I am doing coding for a internal med doc. I got a message today that there's a bunch of Medicare insured patients that are being denied with CPT code G0439. Previous person had been billing 99397; which had also been denied. I think it may be because of the Dx code being used as primary, but they seem to think its the CPT code. Am I incorrect in using the G code for these patients? Can you use a non-G code for medicare? They informed me that they will never perform a "welcome to medicare" physical so there's that too... I don't know what else to look at.

 

[sls314]

You may want to review this MLN on Medicare Annual Wellness Visits: MLN6775421 – Medicare Wellness Visits

 

[TThivierge]

Hi
Medicare has regs on when their patients/subscribers can get annual physicals. G0438 is for the FIRST time any new Medicare patient gets annual physical. But G0439 is for the next year or subsequent years the Medicare patient gets a annual physical. Z00 dx block is for physical for the year but add chronic dx if patient suffers with any. If they do not get required Medicare physical each year ...might get reduction on coverage for something .
Medicare checkup and annual wellness visit focus more on preventive care. The doctor can review for pt. risk factors, develop a personalized health plan for them, check that pt. is up to date with preventive tests such as cancer screenings and flu shots and may refer for other tests.
The CPT included in the two types of Medicare preventive visits are slightly different.
I hope helped you
Lady T

 

[toots9798@hotmail.com]

Hi
Medicare has regs on when their patients/subscribers can get annual physicals. G0438 is for the FIRST time any new Medicare patient gets annual physical. But G0439 is for the next year or subsequent years the Medicare patient gets a annual physical. Z00 dx block is for physical for the year but add chronic dx if patient suffers with any. If they do not get required Medicare physical each year ...might get reduction on coverage for something .
Medicare checkup and annual wellness visit focus more on preventive care. Your doctor can review your risk factors, develop a personalized health plan for you, check that you’re up to date with preventive tests such as cancer screenings and flu shots and may refer you for other tests. The items included in the two types of visits are slightly different.
I hope helped you
Lady T

Thank you for this. I very much suspect that it is the dx code he is wanting to use. I am running a report on these denials to see what codes he has commonly used when these were denied. I appreciate you taking the time to answer!

 

[toots9798@hotmail.com]

You may want to review this MLN on Medicare Annual Wellness Visits: MLN6775421 – Medicare Wellness Visits

I will do so. Thank you for taking the time to answer this.