G0444

[TXBiller]

How do I know when G0444 should be paid by the insurance company and when it is included in a office visit?  Some AETNA plans have paid it while others have not.  I don't understand the difference of when it pays and when it doesn't.

Example:
Aetna POS says

CO-97 PAYMENT ADJUSTED BECAUSE THE BENEFIT FOR THIS SERVICE IS INCLUDED IN THE PAYMENT/ALLOWANCE FOR ANOTHER SERVICE/PROCEDURE THAT HAS ALREADY BEEN ADJUDICATED. 

N19:  PROCEDURE CODE INCIDENTAL TO PRIMARY PROCEDURE.

Thank you

[PMRNC]

First, is this Aetna commercial claim or Medicare plan?

For non medicare 96127 (“Brief emotional/behavioral assessment (e.g., depression inventory, attention-deficit/hyperactivity disorder scale), with scoring and documentation, per standardized instrument.”[)/u]  is what you should use and modifier 59, some carriers want the mod 59 with the screening.

Since you already billed it, they may ask for documentation..IF you did the PHQ-2...cut your losses there. The screening codes should only be used for the PHQ-9. Why doctors think they should get paid for a patient filling out and answering two questions is beyond me. 

For Medicare you would use G0444 (again only PHQ-9) But there must be clinical staff to advise provider of results and can facilitate referrals when necessary. In other words if the provider has no supporting staff or clinical training to assess it can't be billed.  G0444 nor 96127 should NOT be reported separately when it's a part of a routine physical Exam, Welcome to Medicare physical or initial annual wellness.

One more thing.. the dx for the screening should be Z13.89