Author Topic: Denial for medicare charge G0438  (Read 3673 times)

samp

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Denial for medicare charge G0438
« on: February 28, 2012, 01:39:10 PM »
Medicare denied G0438. My original claim was billed as follows 99214, dx 250.00 and G0438, dx V70.0. However I did not put a modifier 25 on the claim. The 99214 was paid, but not the G0438. So I corrected the claim and used modifier 25 and it is still getting rejected. I get error code "duplicate claim" for the 99214 (this is correct as it has been paid). However, the G0438 is still denied, saying "This service/procedure that a qualifying service/procedure be received and covered. The qualifying other service/procedure has not been received/adjudicated." Does anyone have any ideas?

Michele

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Re: Denial for medicare charge G0438
« Reply #1 on: March 01, 2012, 09:02:35 AM »
If you are billing an E&M code along with the G0438 then I believe you must have a modifier to indicate that the E&M was separate from the well visit.  Regarding the well visit, try this site:  http://codingnews.inhealthcare.com/hot-coding-topics/report-picture-perfect-annual-wellness-visits-with-these-5-tips/
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