Coding > Coding
Bundled services G0439 with G0437
djk:
I just didnt want to confuse the situation with a lot of words//LOL I am a biller and just want to get the monies the provider is due and bill correctly to get to that end..I guess the question is should i append a modifier to the G0439.
PMRNC:
I had gotten the impression from your first post that you already tried the modifier 25?
--- Quote ---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
--- End quote ---
The way I understand the smoking cessation G codes is that they are ADD on codes to E/M.. I'm not sure Medicare will pay for it separately within a well visit so I'm not sure modifier 25 would work, if the documentation supports it I suppose you could try but I don't think you can append the modifier 25 to either G code?
http://thehappyhospitalist.blogspot.com/2009/10/cpt-99406-and-99407-and-now-g0436-and.html
Michele:
--- Quote from: djk on May 02, 2014, 01:08:31 PM ---I just didnt want to confuse the situation with a lot of words//LOL I am a biller and just want to get the monies the provider is due and bill correctly to get to that end..I guess the question is should i append a modifier to the G0439.
--- End quote ---
I hope I didn't imply that you were trying to do anything wrong. Just that I see so many billers confuse their position. I do believe that Linda is right. They may not cover it with a well visit but if it is documented I would certainly try the 25 modifier.
barcafan1990:
I'm having this issue now and I'm a bit confused.
We billed a G0439 along with a 99406 (no modifier) and Medicare paid. This was back on 9/17/15 (before the ICD 10 snafu).
On 10/19 (after ICD 10 deadline) we billed Medicare the same G0439 and 99406 (no modifier) for a different pt. This time Medicare denied the service as being a "routine service done in conjunction with a routine exam."
After carefully reviewing both claims, I first realized that neither 99406 even had the "required Dx pointer." On the 9/17 claim that would have been a 305.1 (ICD9) and on the 10/19 claim that would have been F17.200 (ICD10). These Dx were included on the claim but not as the specific Dx pointer for 99406.
That leads me to wonder if Medicare is more carefully reviewing these ICD-10 claims for the "required" Dx pointer before paying. Otherwise were we just lucky to have gotten paid that one claim. Or do I have a case as to why Medicare bundled one 99406 and not the other?
(And no, we had not billed the 8 maximum session yet)
Can anybody provide some insight? Where can I find Medicare's billing guidelines to find out if its supposed to be covered during an AWV. The latest Transmittal 2058 that I found does not specify during what types of visits can this be included with, AWV or E&M?
Michele:
This article talks about billing the 99406. It does state that the E&M needs a 25 modifier. It doesn't mention annual exams. I do think it probably is required though however that doesn't explain why the paid the September one. Personally I would call and speak to a representative to see if I could figure out why the one paid and the other didn't.
https://www.cms.gov/Outreach-and-Education/Medicare-Learning-Network-MLN/MLNMattersArticles/downloads/MM7133.pdf
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