Report Annual Wellness Visits with New G Codes

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In Billing
December 10, 2010
25 Comments
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Complementary annual wellness visits (AWVs) including personalized prevention plan services (PPPS) are just one of the new perks Medicare patients will be entitled to beginning Jan. 1, 2011, courtesy of the Patient Protection and Affordable Care Act of 2010 (Affordable Care Act). The Centers for Medicare & Medicaid Services (CMS) recently issued billing instructions for how these services should be reported to Medicare for reimbursement.

After the first 12 months of coverage, during which time the patient qualifies for an initial preventative physical examination (IPPE), Medicare will pay for an AWV including PPPS. To qualify for coverage, the patient cannot have received an IPPE or AWV within the past 12 months. Medicare coinsurance and Part B deductibles do not apply.

Physicians should report the first AWV including PPPS with HCPCS Level II code G0438 Annual wellness visit; includes a personalized prevention plan of service (PPPS), first visit and subsequent AWVs including PPPS with G0439 Annual wellness visit; includes a personalized prevention plan of service (PPPS); subsequent visit.

G0438 has a relative value unit (RVU) of 2.43, crosswalked from new patient office visit code 99204 and G0439 has an RVU of 1.50, crosswalked from established patient office visit code 99214, according to Coding News.

The first AWV is a one-time allowed Medicare benefit which includes several key elements, such as establishing the patient’s medical and family history, review of systems, etc. (For a complete list of services, and for an explanation of who may perform an IPPE and AWV, refer to CMS Pub. 100-04 Medicare Claims Processing Manual, chapter 12, sections 30.6.1.1 and 100.1.1, and chapter 18, section 140.)

Significant, separately identifiable evaluation and management (E/M) services may be reported in addition to the AWV using CPT® codes 99201-99215. Append modifier 25 to the E/M service code.

25 Responses to “Report Annual Wellness Visits with New G Codes”

  1. Cheryl says:

    1.If the patient had an AWV say in June 2010 can they have the subsequent visit June 2011?
    2.Also, do they have to be on Medicare for 12 months before they can have the initial visit?

  2. Susan says:

    I am wondering if anyone else sees a problem with this question. Both the G codes come up as an incorrect answer which makes no sense to me. What am I missing here?

    Thanks,

    Susan

  3. tama says:

    I am having the same problem as Susan

  4. Kenneth Asch says:

    Some of the instructions are confusing: ie: “there is a crosswalk of RVU for initial AWV for a new patient visit ( 99204)”. How could there be a new patient ( 99204) if patient had an IPPE 12 monts prior, the patient would not be new. This crosswalk would only apply of one could do both an IPPE and an intial AWV at same time, which it says this cannot be done. Can this confusion be cleared up?? Thanks, Ken

  5. Kenneth Asch says:

    I think I figured out my “problem” by reading the Part B news publication.

  6. Hema says:

    Cheryl, if the patient has an AWV on June 15, 2010 then the patients next AWV should be June 16, 2010 or later, NOT June 15, 2010.

  7. crystal says:

    has any one actually gotten paid on these yet? My research does not show that we have a specific ICD9 code we have to use but they are denying ours stating routine not allowed because the ICD9 code is routine?.?. Customer service was no help at all

  8. laura says:

    I haven’t started yet, I spoke with customer service and they stated that the V code for routine should be it, but they had no more information than we do. Also, the implementation date is April 3, 2011, can we enven begin using these codes?

  9. LAURA says:

    I just received a load of denials on the G0438 as “ROUTINE” because we used the V70.0. What ICD-9 is supposed to be used? I called Medicare and they couldn’t give me a straight answer. HELP

  10. Carole says:

    My doctors are seeing payments on the initial AWV. I understand some MCR carriers inadvertantly denied the new codes with routine dx codes, but they realize their error and will reprocess.
    My question is no one ever mentions an EKG with the AWV. I don’t think it is going to be covered with a routine dx. So, I am guessing only the IPPE gets an EKG with routine covered???

  11. Leann says:

    We were billing G0439 and they all got denied during the 1st two weeks of the year. They are now getting reprocessed by medicare and getting paid.

  12. Cindy Walden says:

    What diagnosis code are you using to get paid? I have read several comments that the V70.0 is being denied but I cannot find any advice on what ICD-9-CM code should be linked to the G0438 and G0439. Has anyone found a CMS source?

  13. Maureen says:

    My question is the same as Cindy W. What diagnosis code are we to use? Again, couldn’t get anywhere with Medicare. I have spent the morning researching and I am not able to come up with a clear answer either.

  14. Renee says:

    Denials…denials…denials!!! I am billing G0439 and G0348 with V70.0. DENIED! I am not able to come up with a straight answer as to what ICD-9 to use. Has anyone had a payment…..if so with what ICD-9?

  15. Diane says:

    Seeing comment above made by Leanne, I am wondering why one would bill G0439 this year. If patient already had IPPE, and G0438 was never available until 2011, why would any patient have a “subsequent AWV”. For a patient who is not new to the practice, not new to Medicare, which code to we use first — G0438 (AWV first visit) or G0439 (AWV subsequent)?

  16. Jody says:

    I agree with Diane. My understanding was that the G0438 code was for the first AWV, just in effect this year. Also I understand that you do not have to have had a “Welcome to Medicare visit in order for you to receive benefits under the G0438 code. I read as well where the initial weeks of claims were denied but my claims are still being denied. Has ANYONE, seen payment on the initial AWV code? Thanks

  17. Melissa says:

    I agree also with Dianne. You will bill the G0438 1st for the initial AWV visit and all subsequent visits you would bill the G0439. You can only bill the G0438 if they haven’t had a IPPE within the last 12 months. I am still researching as to which DX code to use with these codes. Those that were getting denied, what was the reason for the denial?

  18. Patti says:

    I just got paid for a G0438 with V70.0 Diag code

  19. Lynnette says:

    Can someone please tell me if am I supposed to be pairing the G0438 and G0439 with another E&M physical code?

  20. Carla says:

    Has anyone be paid for a G0438 with an EKG. I keep getting a denial that the EKG is included in the G0438 code. Why??? Does anyone know????

  21. Betsy says:

    What is the standard charge for the g0439?

  22. Julie says:

    Has anyone tried to bill these codes to Medicare as a secondary? I know the primary will probably not cover it but will Medicare deny this too based on the primary’s processing?

  23. Angela says:

    Im having patients coming in wanting a AWV and a bucket load of labs and no other diag to relate to the labs ..Can I put my labs cpt codes to the G0439 code??

  24. wally says:

    Has anyone tried to bill CPT code G0405 and get denied for a reason once in lifetime benefits. So i bill Patients last year and Patient come back this had another G0405 in the office Medicare will denie it, is there any other way to bill G0405 to get paid? or is there any other code to use to ekg. thanks, i will appreciate all responsea.

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