Wiki G0438 and G0439 Initial Without Subsequent

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tashbelle4

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Hi.
Is it acceptable to bill G0439 without knowing if a patient had an initial visit? If a provider is seeing a new patient, should they bill G0438?
I ask because there is a once in a lifetime limit on G0438 and the provider may not want to risk getting the G0438 denied. Basically, if a patient sees a new PCP each year, does each PCP bill G0438?

Thanks in advance.
 
If a provider is seeing a new patient, the best practice is that they review that patient's records from their previous provider (or if the records are not available, just ask the patient) to find out whether or not they've had an AWV prior to seeing this provider. If so, then you know to bill G0439. If it's not clear, the provider can bill the G0438 for the initial visit, which will be denied if the patient has already had one in the past. I'm a simple fix to resubmit the claim with G0439 if it's denied for that reason.

It's not a good practice to for providers to down-code just because they 'may not want to risk getting' a denial. Providers should do their best to code correctly, and if the code is denied, then address the issue and make the correction based on the new information received at that time.
 
When running Medicare eligibility. it will tell if patient is qualify for G0438 or G0439. So, we know what exact code to use ( Preventive Services Benefit Information).
 
No it is like the commercial well visit. If it was billed by any provider then you can’t bill it. The initial G0402 is billed one time, G0438 can only be billed once and G0439 can be billed each year thereafter.
 
tashbelle4 said:
Hi.
Is it acceptable to bill G0439 without knowing if a patient had an initial visit? If a provider is seeing a new patient, should they bill G0438?
I ask because there is a once in a lifetime limit on G0438 and the provider may not want to risk getting the G0438 denied. Basically, if a patient sees a new PCP each year, does each PCP bill G0438?

Thanks in advance.
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Like the others said, you can check the eligibility when the last AWV was billed if patient every had one m. G0438 is allowed once in a lifetime who has not had their IPPE (G0402) and who is longer within the first 12 months after the effective date of their Medicare Part B Coverage.
 
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