Author Topic: ICD-9 code to use with welcome to medicare visits  (Read 4144 times)

Sally Karr

  • Newbie
  • *
  • Posts: 7
ICD-9 code to use with welcome to medicare visits
« on: June 09, 2009, 03:59:48 PM »
Is V70.8 to be used with G0402 & G0403?   Also...is there a hcpcs code for a welcome to medicare pelvic exam? 

Thanks!!

Michele

  • Global Moderator
  • Hero Member
  • *****
  • Posts: 4764
    • Solutions Medical Billing
Re: ICD-9 code to use with welcome to medicare visits
« Reply #1 on: June 10, 2009, 08:22:52 AM »
The HCPC's you may be looking for is G0101 - Pelvic exam and clinical breast check.  The ICD9 for that would be V76.2 - Special screening for malignant neoplasms; cervix.

As far as the G0402 & G0403 I would think the V70.0 might be more appropriate, unless there is a reason you are using the V70.8 that you didn't mention.

Michele
Sign Up for our FREE Medical Billing Newsletter
Get a 10% discount on Medical Billing Products by using Coupon Code: 10OFF
http://www.solutions-medical-billing.com

Sally Karr

  • Newbie
  • *
  • Posts: 7
Re: ICD-9 code to use with welcome to medicare visits
« Reply #2 on: June 10, 2009, 11:52:42 AM »
Thanks sooo much Michele.  I meant V70.0 but typed V70.8 in error.  Also thanks for the code to use for pelvic exam and clinical breast check.  This helps a lot with some  older bills not submitted by the person doing the coding/billing before I started. 

Sally Karr

  • Newbie
  • *
  • Posts: 7
Re: ICD-9 code to use with welcome to medicare visits
« Reply #3 on: June 10, 2009, 12:03:14 PM »
It's funny how questions come up after getting an answer to one.  Now here's another about these.  If my practitioner does two/three of these preventive visits on a patient in one day, is a modifier needed.  I don't think so but just want to be safe. 

I also want to be sure about needing a 25 modifier if she does an e&m visit with identifiable diagnoses along with any of these preventive visits?  I believe a 25 is needed on the E&M visit.  Am I correct?

THANKS!!

Michele

  • Global Moderator
  • Hero Member
  • *****
  • Posts: 4764
    • Solutions Medical Billing
Re: ICD-9 code to use with welcome to medicare visits
« Reply #4 on: June 12, 2009, 06:47:01 AM »
On the second part of your question, yes, the 25 modifier would be used on the E&M visit if done on the same day as the preventative.

On the first part, isn't there one code that would encompass the two/three codes that you are referring to?  If not, then I don't think a modifier would be necessary.

Michele
Sign Up for our FREE Medical Billing Newsletter
Get a 10% discount on Medical Billing Products by using Coupon Code: 10OFF
http://www.solutions-medical-billing.com

Sally Karr

  • Newbie
  • *
  • Posts: 7
Re: codes to use with medicare prevention visits
« Reply #5 on: June 14, 2009, 11:55:05 PM »
Michele, From what I can tell, for a female patient,and when my practitioner performs each service, I would use a G0402 (Welcome to medicare prevention exam),G0403 ( welcome to medicare ekg), and and G0101 for welcome to medicare pelvic,breast exam.  In addition there is a welcome to medicare prostate exam for men.   My interpretation of the medicare guidelines is that each of these is a separately identifiable procedure/exam and can be billed as such.   and...if the person represents himself/herself with problems that require additional management/care at the time of visit I can bill for an E&M visit.  I am very new to this.  It is an extremely small rural office with many aging patients.  We have many problems with reimbursement/payment and I only want to get her reimbursement for her extremely hard work for, and dedication to, this community. 

I sincerely appreciate your responses to my questions. 

Michele

  • Global Moderator
  • Hero Member
  • *****
  • Posts: 4764
    • Solutions Medical Billing
Re: ICD-9 code to use with welcome to medicare visits
« Reply #6 on: June 15, 2009, 05:47:00 AM »
It sounds like no modifier would be needed.  Each of those G codes is for a different service that would be unrelated to the other.  Are you getting denials when you bill them together?  If you are not having a problem with them being bundled then I would bill then without a modifier.  Except for the E&M code if done on the same visit - as earlier I would definitely use the 25 modifier on that as it is separate and unrelated to the preventative services.

Michele
Sign Up for our FREE Medical Billing Newsletter
Get a 10% discount on Medical Billing Products by using Coupon Code: 10OFF
http://www.solutions-medical-billing.com