Wiki Transition to care and medicare annual wellness

[01085585]

Hi there, our dr. saw a new patient for transition to care from the hosptial. I know I hold that for 30 days after discharge before I bill the transition to care code. The dr did a medicare annual wellness visit on the new patient when she had her 7 day follow up from the hospital. I know I cannot bill the office visit that day because it is included in the TOC code, but can I bill the G0438 (medicare annual wellness)? Thank you!

 

[kwaddles]

Remember that the Transitional Care or TCMS begins (includes) the day of discharge, so if patient was discharged on 10/1/13 then begin counting from 10/1/13. Also it is correct to bill the first time AWV G0438 but I would verify with Medicare (MA/HMO) for eligiblity for G0438 versus G0439. The patient may have had an AWV G0438 with Cahaba then switches to Windsor/UHC/Healthspring etc & may be elig for G0438 again as long as it hasn't been billed to same MCO/HMO/MA. If the G0438 has been billed (once in lifetime code) then you would bill the G0439 which is billed annually.