G0444

[Kerri]

So now we are doing G0444. I can find that this a Medicare only code. But there is conflicting info on if a mod is required if done with an office visit. And I couldn't really find anything more recent than 2016

If done with an OV mod or no mod?  mod 25?    Some articles say no mod on the G code, some say use Mod 33.

Boss says don't worry about it-- just bill it.   

Then there is the diagnosis.  The doc used F41.1, the articles says Z13.31.


HELP ME RHONDA!!!!!(that's YOU michelle)

[Michele]

What I am seeing is that the 25 modifier should be on the OV but no modifier on the G0444.

As for the dx, if you are screening for depression then the reason the test is being done is to screen for depression (Z13.31).  If depression is determined, and more services follow, then the F41.1 would be appropriate for the services.  But the F41.1 wasn't the reason for the G0444, it was the result.

Disclosure:  I am not a certified coder.  This is my opinion from my experiences billing for 30 years.

[kristin]

Mod 25 on E/M code, if billed at same DOS.

Z13.89 is most common dx for G0444 with Medicare, when just screening.

Not a coder, but have billed G0444 for many years for many docs, and Z13.89 is what they all use for dx.

[Kerri]

Billing this WITH and WITHOUT Mod 25, both are denied for bundling.   They are done with a physical and the mod went on that.   

I need any help you guys can give....

[kristin]

You don't say what insurances are denying the code. Although it goes against all billing rules, both Humana MA and UHC MA will often require a 59 modifier on the G0444, when billed with any sort of E/M code, if your denial reason is definitely for bundling.

[Kerri]

Go444 denied by Priority Health Medicare both with and without the 25 for unbundled.

[kristin]

Ok, they could be another weird MA plan that wants a 25 on the E/M, and a 59 on the G0444.

[Michele]

Are you putting the 25 on the E/M or the G0444?  In your posts it sounds like you may be putting it on the G0444 and that may be the problem.

[Kerri]

 I put the 25 on the E/M.  I have sent out two claims with a 59 on the G0444 to see what happens.......