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Tag Archives: Annual

Medicare Annual Wellness Visit and additional Well Woman Exam

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Hello, fellow coders:

One of my providers performed an AWV and a separate well woman exam on two different dates of service. Since both were preventive, triggering use of G0468 (we’re an FQHC), Medicare paid the first well woman visit, but denied the AWV. My billing manager wants the provider to change the CPT code to an office visit (G0467) to get it paid, but the provider coded both correctly as preventive, with SOAP notes corroborating the coding. Has anyone had any luck in getting both an AWV and a well woman visit paid by Medicare?

Thanks,

Medical Billing and Coding Forum

Clarification Needed for Annual and Encounter for Adoption Services

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Good Morning,

A patient came in for an annual visit and stated that she also needs paperwork completed to finalize an adoption. I am a bit confused on how to code this encounter for the following reasons: the sole purpose of the visit is to have a yearly physical and (2) have paperwork completed for adoption services (which is a mandated service). I chose Z00.00 for the primary code and Z02.82 for the secondary code and I did not append mod-32 to the 99396 since the progress note reads:

CC: Physical/Adoption paperwork

HPI: 33 year old female presents with c/o Annual physical exam. Feels well. She is finalizing an adoption next week. She denies sadness and is motivated. She has no special concerns. She is not on OCPs and has been married for 5 yrs.

I need to know if I am supposed to append the mod for a mandated service since the service was included in the encounter and if Z02.82 is appropriate for an adult who is seeking to adopt.

Your help is appreciated!

Thanks,
Trenisha- Future Certified Coder:confused:

Medical Billing and Coding Forum

Annual depression screening (G0444) when the depression diagnosis

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Looking for a definitive reliable specific resource in relationship to Annual depression screening (G0444) when the depression diagnosis occurs on the same day as a result of the screening service.

I’m finding on forums and AAFP article that once the patient is diagnosed with depression (even at the screening appointment) you can no longer use the screening code. It would become part of the E/M service; however I cannot locate the specific source for this information. Can anyone help me locate the source to support this? We have varying opinions in our office so hoping to find something definitive from a reliable source to clear this up.

Any help is much appreciated.

Medical Billing and Coding Forum

Medicare Annual Wellness Visit

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Looking for some guidance/advice on Medicare Annual Wellness billing…

We realized that some of our patients that were seen for their AWV should have been billed as the initial (G0438) and not the subsequent (G0439). We have already received payment from Medicare for the subsequent code. How would you go about correcting this and rebilling for the initial AWV? Is this a "reopening" that I should submit on the Medicare website or should I submit a corrected claim? I’m a fairly new biller so I would greatly appreciate any help on the best way to go about this. Thanks!!

Medical Billing and Coding Forum

Medicare annual

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We have a patient scheduled for an annual Medicare px (not a preop px) G0438 but he is having surgery with another provider prior to our physical appointment so the physical will be within the global period of the sx.

His surgery will have a global period. Will be get paid for the G0438 since I can’t put a 24 modifier on the G code? If they sign an ABN won’t the patient be responsible if Medicare denies the G0439.
I know Medicare won’t accept a mod 25 on the G code so I am assuming they won’t accept a mod 24 either.

Medical Billing and Coding Forum

2018 Annual Update for Clinical Laboratory Fee Schedule

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The codes that are considered a laboratory test under Clinical Laboratory Improvement Amendments (CLIA) change each year. These codes require a facility to have either a CLIA certificate of registration (type code 9), a CLIA certificate of compliance (type code 1), or a CLIA certificate of accreditation (type code 3). A facility with a CLIA […]
AAPC Knowledge Center

Annual Clotting Factor Furnishing Fee Update 2018

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The Centers for Medicare and Medicaid Services (CMS) includes the clotting factor furnishing fee in the published national payment limits for clotting factor billing codes. When the national payment limit for a clotting factor is not included on the Average Sales Price (ASP) Medicare Part B Drug Pricing File or the Not Otherwise Classified (NOC) Pricing File, the MACs make payment for the clotting factor as well as payment for the furnishing fee. For dates of service from January 1, 2018, through December 31, 2018, the clotting factor furnishing fee of $ 0.215 per unit is added to the payment limit for the clotting factor. 


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