Medical Billing Forum

Coding => Coding => Topic started by: Sriram_Sub on June 12, 2013, 12:42:04 PM

Title: Billing medicare for Preventive Medicine E&M codes
Post by: Sriram_Sub on June 12, 2013, 12:42:04 PM
Hello!

We have been billing Medicare for few preventive exams done by our physician but none are being paid. The codes that we use are 99387 or 99397, generally with V70.0. The claims are being denied as "Non Covered charges". I did research on the net and found some sites to mention that those codes can be billed and some telling me not to. I am wondering if I need to use any other alternate code to bill for these services. Your valuable inputs will help me. Thanks.

Regards
Sriram
Title: Re: Billing medicare for Preventive Medicine E&M codes
Post by: PMRNC on June 12, 2013, 01:20:27 PM
Quote
I did research on the net and found some sites to mention that those codes can be billed and some telling me not to. I am wondering if I need to use any other alternate code to bill for these services. Your valuable inputs will help me. Thanks.

this can't be answered without the medical record. I would consult with a certified coder or the physician to see if additional/corrected codes would apply. Under the ACA there are certain instances where well visits are covered however, again, no one can tell you how to code these w/out seeing the medical record.
Title: Re: Billing medicare for Preventive Medicine E&M codes
Post by: RichardP on June 12, 2013, 01:49:34 PM
The key word in your question is MEDICARE.

The Patient Protection and Affordable Care Act of 2010 added a new benefit for Medicare recipients called an Annual Wellness Visit. Contrary to patient and physician expectations, it is not a physical exam or preventive medicine service, as defined by CPT codes 99381-99397. In fact, those services remain noncovered and if billed they will be denied as routine by Medicare.

From here:
http://www.physicianspractice.com/medicares-new-annual-wellness-visit

At this link, see the first column, second row:  "annual wellness visit"

http://www.cms.gov/Medicare/Prevention/PrevntionGenInfo/downloads/MPS_QuickReferenceChart_1.pdf

Note that this chart calls for G0438 (Initial visit) or G0439 (Subsequent visit) with no particular diagnosis code required.  Can bill this for a given patient only once per year.  MEDICARE

You might also read through these two links, as they are somewhat related:

http://www.medicalbillinglive.com/members/index.php?topic=7286.msg22484#msg22484
http://www.medicalbillinglive.com/members/index.php?topic=7198.msg22005#msg22005


Title: Re: Billing medicare for Preventive Medicine E&M codes
Post by: Sriram_Sub on June 12, 2013, 04:16:05 PM
Thanks Linda and Richard! That was helpful.

Regards
Sriram