We have a RN doing the Medicare wellness visits. Does the supervising physician need to be in the clinic when she does them. We are under Noridian
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Tag Archives: wellness
Medicare Wellness Visits
Hi Everyone,
I hope someone can answer a few of questions for me regarding the Medicare visits.
Is it okay to document that a patient refused any of the components of the wellness visits, and if it is so, will it count?
For the Welcome to Medicare Visit/IPPE/G0402, what if it is not performed, but documented that patient has an ophthalmologist or optometrist?
If the provider documents in the exam that visual acuity is grossly intact, is that acceptable? Or what would be in the absence of actual results like 20/40 right eye, 20/20 left eye?
I appreciate any help anyone can give me; thank you!
Depression Screening during Medicare Wellness
Hi!
I recently read that you are allowed to bill G0444 Depression Screening during a subsequent (G0439) Medicare Wellness Visit. Does anyone know if the PHQ-9 screener qualifies for billing? Also, if our provider reviews and discusses POLST and Advance Care Planning during the same visit, do you see any problems with billing all three at the same visit? G0439, G0444, 99497 (Does G0444 require the same -33 modifier as the advance care planning so the copay and deductible are waived?)
Thanks, in advance!! I appreciate any input!
Medicare Annual Wellness Visit
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!!
Reimbursement for OV with a wellness exam
Is anyone having problems with an OV (99212-99215) being paid when billed with a wellness exam. Modifier 25 was used with the dx being encounter for routine child health examination with abnormal findings and the diagnoses as secondary for the abnormal findings. Insurance denied the OV as being included in the payment for another service. Under appeal they upheld their denial stating separate reimbursement is not allowed for the lesser level E/M service code and providers should select a level of service representative of the combined services and submit the appropriate code for that level.
This is how we have been coding an OV with a preventative and have had no problems with reimbursement. Is anyone having this same issue and have any input?
Thanks,
Tina
CPC
Reimbursement for OV with a wellness exam
Is anyone having problems with an OV (99212-99215) being paid when billed with a wellness exam. Modifier 25 was used with the dx being encounter for routine child health examination with abnormal findings and the diagnoses as secondary for the abnormal findings. Insurance denied the OV as being included in the payment for another service. Under appeal they upheld their denial stating separate reimbursement is not allowed for the lesser level E/M service code and providers should select a level of service representative of the combined services and submit the appropriate code for that level.
This is how we have been coding an OV with a preventative and have had no problems with reimbursement. Is anyone having this same issue and have any input?
Thanks,
Tina
CPC
BCBS wellness coverage/Arkansas
I have recently learned that BCBS will no longer cover at 100% more than one wellness visit per year including the gynecology wellness. In the past, women have gotten both covered at 100%. I was told that I could use S0610/S0612-Annual GYN wellness new/established but I don’t know what dx code should be used. Does anyone have experience using this code for GYN wellness?
Thanks, Judy
Reimbursement for OV with a wellness exam
Is anyone having problems with an OV (99212-99215) being paid when billed with a wellness exam. Modifier 25 was used with the dx being encounter for routine child health examination with abnormal findings and the diagnoses as secondary for the abnormal findings. Insurance denied the OV as being included in the payment for another service. Under appeal they upheld their denial stating separate reimbursement is not allowed for the lesser level E/M service code and providers should select a level of service representative of the combined services and submit the appropriate code for that level.
This is how we have been coding an OV with a preventative and have had no problems with reimbursement. Is anyone having this same issue and have any input?
Thanks,
Tina
CPC
Reimbursement for E/M for Illness at Wellness exam
Anyone else having problems with FULL reimbursement for the OV (99212-99214) when billing it with a wellness exam (99391-99395)? Reimbursement was always @100% as long as it was coded with modifier 25, now we are only being reimbursed 50%.
Thanks!
Kim Krebs,
CPEDC
Coding a Medicare Wellness Exam & Complete Physical Together
I’m hoping someone can answer this because I am finding conflicting information in other post or on-line and there is a debate in our office with providers on how to do this. If a patient comes in for their Annual Medicare Exam (G0439) and request a physical as well how would you code both exams? Would you code it as G0439 with an E/M code plus modifier 25 or G0439 with an age preventive visit code with modifier 25?
Thank you,
Lisa