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Now taking classes is a great start, but only a start. It will take you another good year or so in a medical billing position, getting hands on experience, to really be able to understand all the concepts. The learning will then continue throughout your career. Remember, Attention to Detail.
Best wishes to you --Manny
Hope this helps --Manny
Many providers believe that the Annual Wellness Visit (AWV, G0438 and G0439) is the same as a Routine Preventative Exam. My guess is they are going by what they may have heard in the media that Medicare covers check-ups. The media has been misinforming doctors and patients. A Routine Preventative Exam and AWV are two different services. The AWV has very specific questions that a providers must ask and properly document in order to be able to bill for the service. Take a close look at the requirements in the CMS MLN Matters Publication MN7079 and then take a look at the requirements for 99387/99389 Routine Physical in your CPT book and you will be able to see that the two services are completely different.
I foresee providers documenting the AWV as a Routine Physical and not documenting what is required by the AWV, getting audited and having to return the money (plus penalties) to Medicare because the documentation does not support the G0438 coding.
If your physicians are performing both a 99387/99397 and a G0438/G0439 they should bill for both and get paid for both. --Manny
That said, if the only service you are providing is giving a flu shot, at best you can only bill a level 1 but even that is not billed any more these days. The administration of vaccine code 90471 or G0008 for Medicare is about all you can bill allong with the influenza vaccine codes.
Is there anything else to this story? Are they telling you why? What diagnosis are you using for the E/M visit? Is it different?
I know I am asking more questions but this seams very odd and interesting. --Manny
Polly I am not sure if I am answering your question but once you include the NDC in the code tables of your practice management system everyone gets it. --Manny
What was the denial code you received from Medicare? It could be something as simple as frequency (since this is a new patient to your practice they could have had the G0438 with another provider and you need to bill out the G0439 instead) or missing a referring physician, etc.
Let me know what you find. --Manny