Wiki Medicare Annual Wellness Codes

[kconjon]

I need assistance with changing of Annual Wellness codes for payment? Patients who are having their Medicare Annual Wellness visit for the first time(initial) are being billed out as G0438. When explanation of benefits come back with denials because the patient has had a claim with the same code previously (not in our office), it has been brought to my attention the payment posters are automatically changing the code to a G0439 and submitting the claims back out for payment.

I wanted to know if this is correct or would this fall under fraudulent billing in order to get paid?

Your assistance with this matter will be greatly appreciated.

KimberlyJ

 

[ehanna]

It wouldn't be fraudulent because it was a subsequesnt AWV, the patient just didn't tell you they had the first one, the only thing that might hold up the payment would be if the time between AWV's wasn't long enough.

I hope this helps

E

 

[cheermom68]

Just be careful of the required time-frame. Our offices check the MAC website to determine eligibility for the service and when and if they have had it done previously.

 

[kconjon]

Thank you this helps tremendously! I appreciate the advice!