This is the resource guide from CodingIntel's one hour course on preventive medicine. Coding for preventive medicine services should be easy, but it's not. It's complicated by frequency issues, Medicare rules and the always difficult issue of when to bill a problem oriented E/M service on the same day. If you need more information, in July, 2018, we are posting detailed information about Medicare HCPCS screening and counseling codes, … [Read more...]
Screening for depression | HCPCS code G0444
Annual depression screening code G0444 Medicare pays primary care practices to screen all Medicare patients annually for depression. The service must be provided in a primary care setting, in place of service office, outpatient hospital, independent clinic or in a state or local health department. This service is paid using HCPCS code G0444, annual depression screening, 15 minutes. The reimbursement is relatively low, about $26 for the … [Read more...]
Preventive Medicine Services – Medicare
Medicare has very specific requirements for preventive services. What can you bill, what must you document? This article covers all the bases including tips for billing the Welcome to Medicare and Annual and Subsequent Wellness Visits. More tips for preventive medicine and split visits can be found here. Definition Traditional Medicare does not pay for routine services reported with codes 99381—99397. Preventive Codes Medicare Covers … [Read more...]
Wellness visits and care management in Rural Health Centers and Federally Qualified Health Centers (RHCs and FQHCs)
RHCs and FQHCs are paid an all-inclusive rate (AIR) or national prospective payment system (PPS) rate for any service that is defined as a visit to their facility. A visit may be with a physician, non-physician practitioner (NPP), psychologist or social worker. There are some differences in RHC and FQHC rules, but in general, a visit identified by a CPT code is submitted with a revenue code and is paid at the AIR for each type of facility. … [Read more...]
Are you missing the initial annual wellness visit? | G0438
After I gave a presentation at a family medicine conference a physician said to me, “What you just told me will pay for the entire cost of my coming to this conference.” I don’t always hear that after I give a presentation. Sometimes I hear the opposite. Incorrect coding equals lost revenue The mistake he was making that was costing him money is the same mistake I saw recently in a large primary care group. It was billing a subsequent annual … [Read more...]
Age and wellness visits | Eligibility for Welcome to Medicare
Question: Does the patient need to be 65 years old in order to bill the Welcome to Medicare Visit? Answer: No, there is no age restriction for billing Medicare for the Welcome to Medicare visit, the initial annual wellness visit or the subsequent annual wellness visit. Although we think of people being eligible for Medicare at age 65, there are many individuals who are eligible for Medicare at a younger age, because they have … [Read more...]
Wellness visits and prolonged care | How to use G0513 & G0514
Medicare stunned us by creating two prolonged services HCPCS codes for use with Medicare covered preventive medicine services in 2018. They may be used only with Medicare covered preventive services when the typical intraservice time for the preventive service is met, and half of the prolonged care time. CMS then released the intraservice time for each code. See the cheat sheet including preventive services codes, intraservice time and the … [Read more...]
Billing for pap smear
Medical practices often ask what codes to use in order to bill for a pap smear provided during a preventive medicine service or other E/M service. The only CPT codes specifically for pap smears are for use by a pathologist, for the interpretation of the cytology specimen. CPT codes in the lab section, 88000 series, should not be reported by the office physician who collects the pap smear. Those codes are used by the pathologist who provides the … [Read more...]
Can you screen for an existing condition? | Diagnosis Coding for Lab Services
Can you screen for an existing condition, “In the absence of any signs, symptoms or associated diagnosis” Sometimes, the hardest thing about coding for preventive services isn’t the visit at all. It’s the labs. Patients come in for an annual physical and many times they believe that all of the lab work done that day or in preparation for that day will be covered as part of their preventive service. And we know what that means to patients. … [Read more...]
Reporting a problem-oriented visit on the same day as Welcome to Medicare (G0402) or Initial and Subsequent Wellness Visit (G0438, G0439)
To do or not to do? When can you report a problem oriented visit with the Welcome to Medicare (G0402), or Initial or Subsequent (G0438, G0439) Medicare Wellness Visits? If you’ve read anything I’ve written on this topic or watched my videos, you know my opinion: If the physician/NP/PA treats and documents an acute or chronic problem during the same encounter as a wellness visit, bill both a Welcome to Medicare or Wellness Visit on the same … [Read more...]
Everyday Coding
How can a practice increase its revenue? The easiest way is by collecting for services already performed, and the first step in that process is accurate CPT coding. Everyday Coding is Betsy's signature course. We've gathered all the components here in one convenient spot. You can work through them one at a time, select just the ones you need, or customize training for your physicians and staff. You can find supplementary content by … [Read more...]
Billing a problem oriented visit with a preventive service
Two for the price of one, or report both a problem oriented visit and a preventive service? This video includes CPT and Medicare guidelines for deciding if you can bill both the E/M service and the preventive service, or if you must select only one. After watching, check out this article for some additional resources. … [Read more...]
Examination Codes in ICD-10
In ICD-10-CM, diagnosis coding for preventive medicine services are divided as with or without abnormal findings. Learn about 'Z' codes in this 5 minute video on examination codes in ICD-10... … [Read more...]
Can I get paid for…a problem oriented visit and wellness visit on the same day
Many patients come for their annual exam with a list of concerns. Or, the clinicians wants to treat chronic problems on the day of the preventive service. Can I get paid for a problem oriented visit and a wellness visit on the same day? Find out how in this short video. https://player.vimeo.com/video/170232049 Back to list Relevant Search Terms: G0438, G0402, preventive medicine, wellness visits, office … [Read more...]
Performing services that increase primary care revenue
CMS states it wants to increase pay to primary care physicians. And while we might quarrel with their strategies or with the speed of achieving the goal, few would quarrel with the goal itself. In recent years, CMS has developed HCPCS codes and adopted CPT codes, some limited to primary care and some not specialty restricted but all likely to be reported by primary care practices. Meanwhile, although payment systems are moving to outcome … [Read more...]