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Bundled services G0439 with G0437

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djk:
I am billing for a annual well visit (G0439-  modifer 25,Dx V70.0) and  for smoking cessation (G0437 DX 305.1), Medicare is bundling these services

Michele:
Not sure if you had a question.  Do you feel that the smoking cessation should be allowed separately?  I believe that their guidelines specify that the service is included/bundled with the well visit unless there is something to indicate that the service was separate.

djk:
I think that should not be bundled services

Michele:
You are a person of few words.  LOL  You are still leaving me with some questions.  Are you the biller?  I'm asking because I'm wondering why you feel that they should be separate.  Don't get me wrong, I'm not saying it is wrong to think they should be separate, just trying to get your angle.  I bill for a doc who does smoking cessation as well.  What I'm getting at is this.....  we can think something should be allowed separate but if the particular insurance carrier rule is that it isn't then there isn't much that can be done.  As a biller we have to be careful that we don't try so hard to get something paid that we actually alter the billing to do it.  The billing must match what is in the chart.  So for example:

Pt comes in for a well visit.  Dr performs well visit and also does smoking cessation.  It gets billed out as G0439 and G0437.  Medicare states that G0437 is inclusive of G0439, they don't allow it separate.  Period.  Even if the chart clearly shows dr performed complete check up, and then spent additional 10+ minutes on smoking cessation, it is not payable separate.   The biller believes it should be allowed separate so they append different modifiers etc in an effort to get them paid.  Maybe the biller even tries to bill a 99211 or other code.  This is not good.

Now if the Medicare guidelines state that if the smoking cessation is done along with another service but it is separate and a modifier can be appended to indicate that, then they will allow it separately, then that is different.  But the biller shouldn't just append the modifier to ensure the payment, they must make sure that the modifier is appropriate and that the patient's chart indicates that. 

We just have to remember that we are billing out what is performed exactly as it is performed to report it to the insurance carrier.  We are not billing just to ensure payment.  I'm sure everybody is up in arms right now, but hear me out.  I see so many billers get lost in "how do I get this paid?"  That is not the right question.  The question should be "am I billing this correctly."  Sometimes things are just not covered and it's patient responsibility, or the provider agreed to not bill separately in their contract.  Us billers are not magicians, we are just experts at billing correctly.  (Sometimes we need to get assistance from others to perform our jobs and to learn.)  Our job is not solely to make sure the provider gets paid, but to make sure the provider is reimbursed for all that they are entitled to in a timely manner and to make sure that the claims are being billed properly.

Ok not sure how I got that far off.  I hope I was helpful.  :) 

PMRNC:

--- Quote ---We just have to remember that we are billing out what is performed exactly as it is performed to report it to the insurance carrier.  We are not billing just to ensure payment.  I'm sure everybody is up in arms right now, but hear me out.  I see so many billers get lost in "how do I get this paid?"  That is not the right question.  The question should be "am I billing this correctly."  Sometimes things are just not covered and it's patient responsibility, or the provider agreed to not bill separately in their contract.  Us billers are not magicians, we are just experts at billing correctly.  (Sometimes we need to get assistance from others to perform our jobs and to learn.)  Our job is not solely to make sure the provider gets paid, but to make sure the provider is reimbursed for all that they are entitled to in a timely manner and to make sure that the claims are being billed properly.
--- End quote ---

WONDERFULLY SAID!!!!!!!! 

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