Medical Billing Coding - Annual wellness visit, cpt, codes
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Thread Topic: Annual wellness visit
Topic Originator: Adarsh
Post Date July 29, 2013 @ 5:02 PM
Annual wellness visit


Adarsh
July 29, 2013 @ 5:02 PM Reply  |  Email Friend   |  |Print  |  Top

Hi,

I have patient who actually came for annual physical examination. Meanwhile He also reported abdominal pain. And patient has medicare.

Could anyone please help me how should I report both of them.

Should I bill G0439- V70.0 + Office visit

Report both dx code along with CPT G0439.

Please advise. Looking for quick response.

Thanks,
Adarsh

Josh
August 16, 2013 @ 8:53 AM Reply  |  Email Friend   |  |Print  |  Top

We bill 99215 -59  for the abdominal pain, G0438 -25 for the wellness visit we use V70.00 for our diagnosis. If that doesn't work we use V70.30

Joan Gilhooly
August 29, 2013 @ 4:59 PM Reply  |  Email Friend   |  |Print  |  Top

Adarsh

I don't know if it was a typo in your original question, but Medicare's new "annual wellness visit" (G0438-G0439) isn't the same as an "annual physical exam".

First of all, Medicare doesn't pay for "annual physical exams".  Those have been statutorily excluded services since the Medicare program started back in the 1960s - and still are excluded services that the patient has to pay for themselves.

The "annual wellness visit" is an opportunity to sit down with the clinical staff in the office (yes, the physician doesn't even have to personally provide this service) to be screened for things like depression, risk for falls, etc and to establish a schedule for when the patient needs the next covered preventive services (such as when they should receive their next colonoscopy, when the next time they're eligible for glucose testing for diabetes screening, when they should get their next mammogram, dexascan, etc.  I just wanted to make sure that "annual physical" was a typo and you really were talking about the practice having done all of the things that are required for the G0438-G0439 services.

In either case, if it was medically necessary to work up a medical complaint like abdominal pain that was ALSO presented at this visit, then yes, the additional work that went into working up that problem can be separately reported with a 99201-99215 code.  That said, though, I disagree with Josh's assumption that the work up for the abdominal pain would typically be a 99215 service.  I think in most cases -- unless the abdominal pain ends up being a potentially life threatening medical emergency, you're going to find that the additional work up for that problem will be somewhere between 99213-99214 (and possibly even 99212 if it was done at the time of a true "complete physical")

JMHO......

Joan Gilhooly
August 29, 2013 @ 5:03 PM Reply  |  Email Friend   |  |Print  |  Top

Oops - forgot to answer the ICD9 part of your question.

No, you wouldn't report V70.0 and 789.xx (for the abdominal pain) for BOTH services.  You'd link the V70.0 to the G0439 and you'd link 789.xx (the code for the abdominal pain) to the 9921x problem oriented E/M service.

Hope this helps!

Joan Gilhooly
August 29, 2013 @ 5:03 PM Reply  |  Email Friend   |  |Print  |  Top

Oops - forgot to answer the ICD9 part of your question.

No, you wouldn't report V70.0 and 789.xx (for the abdominal pain) for BOTH services.  You'd link the V70.0 to the G0439 and you'd link 789.xx (the code for the abdominal pain) to the 9921x problem oriented E/M service.

Hope this helps!

Adarsh
September 5, 2013 @ 10:28 AM Reply  |  Email Friend   |  |Print  |  Top

Thanks a lot



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