Medical Billing Forum
Coding => Coding => : Sally Karr June 09, 2009, 06:59:48 PM
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Is V70.8 to be used with G0402 & G0403? Also...is there a hcpcs code for a welcome to medicare pelvic exam?
Thanks!!
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The HCPC's you may be looking for is G0101 - Pelvic exam and clinical breast check. The ICD9 for that would be V76.2 - Special screening for malignant neoplasms; cervix.
As far as the G0402 & G0403 I would think the V70.0 might be more appropriate, unless there is a reason you are using the V70.8 that you didn't mention.
Michele
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Thanks sooo much Michele. I meant V70.0 but typed V70.8 in error. Also thanks for the code to use for pelvic exam and clinical breast check. This helps a lot with some older bills not submitted by the person doing the coding/billing before I started.
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It's funny how questions come up after getting an answer to one. Now here's another about these. If my practitioner does two/three of these preventive visits on a patient in one day, is a modifier needed. I don't think so but just want to be safe.
I also want to be sure about needing a 25 modifier if she does an e&m visit with identifiable diagnoses along with any of these preventive visits? I believe a 25 is needed on the E&M visit. Am I correct?
THANKS!!
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On the second part of your question, yes, the 25 modifier would be used on the E&M visit if done on the same day as the preventative.
On the first part, isn't there one code that would encompass the two/three codes that you are referring to? If not, then I don't think a modifier would be necessary.
Michele
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Michele, From what I can tell, for a female patient,and when my practitioner performs each service, I would use a G0402 (Welcome to medicare prevention exam),G0403 ( welcome to medicare ekg), and and G0101 for welcome to medicare pelvic,breast exam. In addition there is a welcome to medicare prostate exam for men. My interpretation of the medicare guidelines is that each of these is a separately identifiable procedure/exam and can be billed as such. and...if the person represents himself/herself with problems that require additional management/care at the time of visit I can bill for an E&M visit. I am very new to this. It is an extremely small rural office with many aging patients. We have many problems with reimbursement/payment and I only want to get her reimbursement for her extremely hard work for, and dedication to, this community.
I sincerely appreciate your responses to my questions.
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It sounds like no modifier would be needed. Each of those G codes is for a different service that would be unrelated to the other. Are you getting denials when you bill them together? If you are not having a problem with them being bundled then I would bill then without a modifier. Except for the E&M code if done on the same visit - as earlier I would definitely use the 25 modifier on that as it is separate and unrelated to the preventative services.
Michele