Re: Could you please help to identify the invalid codes for medicare Annual Wellness Visits?

[Guest guest]

Some of them had been billed G0438 before and some had annual physicals done many times after turning 65 yo with only 9921x billed for those visits. Some new patients could not tell me if their prior doc had billed G0438 before or not.Should I resubmit with G0438 with V70.0 and leave out the G and Q codes?Thank you very much.HelenTo: From: qualityfp@...Date: Thu, 26 Jan 2012 13:16:27 -0500Subject: RE: Could you please help to identify the invalid codes for Medicare Annual Wellness Visits?

Also, I would use the ICD V70.0 with the G0439 or G0438 as that is the physical code. “I don’t think Medicare will pay for a breast and PAP at the same time as any other E & M code. And PAP is only every 3 years. For the Q0091 you actually code V76.2. Otherwise I don’t know why you would get the “invalid code” message and I have always found it useful to call the Medicare provider rep as they are usually helpful. Kathy Saradarian, MDBranchville, NJwww.qualityfamilypractice.comSolo 4/03, Practicing since 9/90Practice Partner 5/03Low staffing From: [mailto: ] On Behalf Of PrattSent: Thursday, January 26, 2012 12:19 PMTo: Subject: Re: Could you please help to identify the invalid codes for Medicare Annual Wellness Visits? Have you billed G0438 for these patients? It is my understanding that you must bill that before G0439. Hard to have a "subsequent" when you haven't done an"initial.". G0438 cannot be billed in first year of having Medicare, because it you have to do the IPPE code (G0402). Then, once you have billed G0438, you wait a year before billing G0439. Hope that helps, Pratt Dear all,I had never billed Medicare the breast exam and Pap smear codes before for the GYN annuals we had done before. Tried for the first time yesterday, but bounced back by the clearing house under "invalid procedure codes" (but it did not indicate which one was invalid). Could you please help to take a look which one is wrong? I first wondered if the clearing house made a mistake, but same "invalid codes" messages showed on 3 other medicare annual claims too this week.For a female GYN annual + EM: G0439 -------------- V72.31 99214 -25 ------- 250.02, 401.1, 272.4, 733.09 G0101--------------- V72.31 Q0091----------------V72.31For a male pt annual: G0439 ------------ V70.0 99213 -25-------- 272.4, 600.00, 268.9, 477.9Would you please let me know how to make the corrections? Thank you very much in advance.Helen

[Guest guest]

Helen,This is the first year with G0438 and G0439 so this is the first year it can be billed. If their previous doctor had done it this year, you can’t get paid. A 9921* is not an annual physical so it won’t count at all. That is an E & M. I would still bill the G and Q codes, it might must be denied as bundled and not separately billable. Or you do them at a separate visit. Kathy Saradarian, MDBranchville, NJwww.qualityfamilypractice.comSolo 4/03, Practicing since 9/90Practice Partner 5/03Low staffing From: [mailto: ] On Behalf Of Helen YangSent: Thursday, January 26, 2012 2:54 PMTo: IMP GroupSubject: RE: Could you please help to identify the invalid codes for Medicare Annual Wellness Visits? Some of them had been billed G0438 before and some had annual physicals done many times after turning 65 yo with only 9921x billed for those visits. Some new patients could not tell me if their prior doc had billed G0438 before or not.Should I resubmit with G0438 with V70.0 and leave out the G and Q codes?Thank you very much.HelenTo: From: qualityfp@...Date: Thu, 26 Jan 2012 13:16:27 -0500Subject: RE: Could you please help to identify the invalid codes for Medicare Annual Wellness Visits? Also, I would use the ICD V70.0 with the G0439 or G0438 as that is the physical code. “I don’t think Medicare will pay for a breast and PAP at the same time as any other E & M code. And PAP is only every 3 years. For the Q0091 you actually code V76.2. Otherwise I don’t know why you would get the “invalid code” message and I have always found it useful to call the Medicare provider rep as they are usually helpful. Kathy Saradarian, MDBranchville, NJwww.qualityfamilypractice.comSolo 4/03, Practicing since 9/90Practice Partner 5/03Low staffing From: [mailto: ] On Behalf Of PrattSent: Thursday, January 26, 2012 12:19 PMTo: Subject: Re: Could you please help to identify the invalid codes for Medicare Annual Wellness Visits? Have you billed G0438 for these patients? It is my understanding that you must bill that before G0439. Hard to have a " subsequent " when you haven't done an " initial. " . G0438 cannot be billed in first year of having Medicare, because it you have to do the IPPE code (G0402). Then, once you have billed G0438, you wait a year before billing G0439. Hope that helps, Pratt Dear all,I had never billed Medicare the breast exam and Pap smear codes before for the GYN annuals we had done before. Tried for the first time yesterday, but bounced back by the clearing house under " invalid procedure codes " (but it did not indicate which one was invalid). Could you please help to take a look which one is wrong? I first wondered if the clearing house made a mistake, but same " invalid codes " messages showed on 3 other medicare annual claims too this week.For a female GYN annual + EM: G0439 -------------- V72.31 99214 -25 ------- 250.02, 401.1, 272.4, 733.09 G0101--------------- V72.31 Q0091----------------V72.31For a male pt annual: G0439 ------------ V70.0 99213 -25-------- 272.4, 600.00, 268.9, 477.9Would you please let me know how to make the corrections? Thank you very much in advance.Helen

[Guest guest]

Helen:

Q and G PAP codes are not billable when an E/M visit is billed. It is considered part of the E/M service.

Subject: Could you please help to identify the invalid codes for medicare Annual Wellness Visits?To: "IMP Group" <practiceimprovement1 >Date: Thursday, January 26, 2012, 9:31 AM

Dear all,I had never billed Medicare the breast exam and Pap smear codes before for the GYN annuals we had done before. Tried for the first time yesterday, but bounced back by the clearing house under "invalid procedure codes" (but it did not indicate which one was invalid). Could you please help to take a look which one is wrong? I first wondered if the clearing house made a mistake, but same "invalid codes" messages showed on 3 other medicare annual claims too this week.For a female GYN annual + EM: G0439 --------------

V72.31 99214 -25 ------- 250.02, 401.1, 272.4, 733.09 G0101---------------

V72.31 Q0091----------------V72.31For a male pt annual: G0439 ------------ V70.0 99213 -25-------- 272.4, 600.00, 268.9, 477.9Would you please let me know how to make the corrections? Thank you very much in advance.Helen

[Guest guest]

I would try that, but as Kathy said, if you call and wait on hold for your Medicare carrier, they will tell you exactly why it denied. Of course, they will usually only tell you ONE reason why it denied, so sometimes you end up resubmitting multiple times before you get it right.

Some of them had been billed G0438 before and some had annual physicals done many times after turning 65 yo with only 9921x billed for those visits. Some new patients could not tell me if their prior doc had billed G0438 before or not.Should I resubmit with G0438 with V70.0 and leave out the G and Q codes?Thank you very much.HelenTo: From: qualityfp@...Date: Thu, 26 Jan 2012 13:16:27 -0500Subject: RE: Could you please help to identify the invalid codes for Medicare Annual Wellness Visits?

Also, I would use the ICD V70.0 with the G0439 or G0438 as that is the physical code. “I don’t think Medicare will pay for a breast and PAP at the same time as any other E & M code. And PAP is only every 3 years. For the Q0091 you actually code V76.2. Otherwise I don’t know why you would get the “invalid code†message and I have always found it useful to call the Medicare provider rep as they are usually helpful. Kathy Saradarian, MDBranchville, NJwww.qualityfamilypractice.comSolo 4/03, Practicing since 9/90Practice Partner 5/03Low staffing From: [mailto: ] On Behalf Of PrattSent: Thursday, January 26, 2012 12:19 PMTo: Subject: Re: Could you please help to identify the invalid codes for Medicare Annual Wellness Visits? Have you billed G0438 for these patients? It is my understanding that you must bill that before G0439. Hard to have a "subsequent" when you haven't done an"initial.". G0438 cannot be billed in first year of having Medicare, because it you have to do the IPPE code (G0402). Then, once you have billed G0438, you wait a year before billing G0439. Hope that helps, Pratt Dear all,I had never billed Medicare the breast exam and Pap smear codes before for the GYN annuals we had done before. Tried for the first time yesterday, but bounced back by the clearing house under "invalid procedure codes" (but it did not indicate which one was invalid). Could you please help to take a look which one is wrong? I first wondered if the clearing house made a mistake, but same "invalid codes" messages showed on 3 other medicare annual claims too this week.For a female GYN annual + EM: G0439 -------------- V72.31 99214 -25 ------- 250.02, 401.1, 272.4, 733.09 G0101--------------- V72.31 Q0091----------------V72.31For a male pt annual: G0439 ------------ V70.0 99213 -25-------- 272.4, 600.00, 268.9, 477.9Would you please let me know how to make the corrections? Thank you very much in advance.Helen

[Guest guest]

2011 was actually the first year for G0438. If the patient had a G0438 in the last 365 days, it will deny no matter what with the G0439.

Helen,This is the first year with G0438 and G0439 so this is the first year it can be billed. If their previous doctor had done it this year, you can’t get paid. A 9921* is not an annual physical so it won’t count at all. That is an E & M. I would still bill the G and Q codes, it might must be denied as bundled and not separately billable. Or you do them at a separate visit. Kathy Saradarian, MDBranchville, NJwww.qualityfamilypractice.comSolo 4/03, Practicing since 9/90Practice Partner 5/03Low staffing From: [mailto: ] On Behalf Of Helen YangSent: Thursday, January 26, 2012 2:54 PMTo: IMP GroupSubject: RE: Could you please help to identify the invalid codes for Medicare Annual Wellness Visits? Some of them had been billed G0438 before and some had annual physicals done many times after turning 65 yo with only 9921x billed for those visits. Some new patients could not tell me if their prior doc had billed G0438 before or not.Should I resubmit with G0438 with V70.0 and leave out the G and Q codes?Thank you very much.HelenTo: From: qualityfp@...Date: Thu, 26 Jan 2012 13:16:27 -0500Subject: RE: Could you please help to identify the invalid codes for Medicare Annual Wellness Visits? Also, I would use the ICD V70.0 with the G0439 or G0438 as that is the physical code. “I don’t think Medicare will pay for a breast and PAP at the same time as any other E & M code. And PAP is only every 3 years. For the Q0091 you actually code V76.2. Otherwise I don’t know why you would get the “invalid code†message and I have always found it useful to call the Medicare provider rep as they are usually helpful. Kathy Saradarian, MDBranchville, NJwww.qualityfamilypractice.comSolo 4/03, Practicing since 9/90Practice Partner 5/03Low staffing From: [mailto: ] On Behalf Of PrattSent: Thursday, January 26, 2012 12:19 PMTo: Subject: Re: Could you please help to identify the invalid codes for Medicare Annual Wellness Visits? Have you billed G0438 for these patients? It is my understanding that you must bill that before G0439. Hard to have a "subsequent" when you haven't done an"initial.". G0438 cannot be billed in first year of having Medicare, because it you have to do the IPPE code (G0402). Then, once you have billed G0438, you wait a year before billing G0439. Hope that helps, Pratt Dear all,I had never billed Medicare the breast exam and Pap smear codes before for the GYN annuals we had done before. Tried for the first time yesterday, but bounced back by the clearing house under "invalid procedure codes" (but it did not indicate which one was invalid). Could you please help to take a look which one is wrong? I first wondered if the clearing house made a mistake, but same "invalid codes" messages showed on 3 other medicare annual claims too this week.For a female GYN annual + EM: G0439 -------------- V72.31 99214 -25 ------- 250.02, 401.1, 272.4, 733.09 G0101--------------- V72.31 Q0091----------------V72.31For a male pt annual: G0439 ------------ V70.0 99213 -25-------- 272.4, 600.00, 268.9, 477.9Would you please let me know how to make the corrections? Thank you very much in advance.Helen

[Guest guest]

Actually you can bill pap and pelvic/CBE WITH an E & M service and the frequency of the pap depends on the risk of the patient. Medicare will pay for a yearly pap for high risk women. Medicare considers a woman at high risk if she:• Is of childbearing age; • Has a prior history of cancer or sexually transmitted disease; • Has been infected with human papilloma viruses (HPVs). • Had an abnormal Pap smear within the past three years; • Began having sexual intercourse before age 16; • Has had more than five sexual partners; • Has not had a Pap smear within seven years; and/or • Has a mother who used diethylstilbestrol (DES) during

pregnancy.Otherwise, they pay every two years.For men, you CANNOT bill for a DRE with an E & M code. RE: what diagnosis code to use with the AWV, this is direct from CMS questions/answers: "A

diagnosis code must be reported, however, CMS does not require a specific diagnosis code for the Annual Wellness Visit (AWV). Therefore, providers can choose any appropriate diagnosis code."I'm guessing that you might have been denied because these patients never had their initial AWV billed- if they were your patients in 2011 and you didn't do it, then it wasn't done unless they went to someone else just for that. My understanding is the subsequent visit will be denied if the initial has never been billed. We are now into the second year of AWVs as of 1/1/12 ... during all of 2011 only the G0438 code could be billed... now, one can bill the G0439 IF the G0438 has been billed once for that patient already.. at least 12 months previously.Here is an older guide to billing preventive services- it does not address the new

AWVs or IPPEhttp://www.acponline.org/running_practice/practice_management/payment_coding/medicare/pb_coding.pdfHere is a short blurb from Medicare that is helpful: http://www.cms.org/uploads/NewMedicarePreventiveServices.pdfHelen, keep after it- it is well worth it!Carla To:

Sent: Thursday, January 26, 2012 3:00 PM Subject: Re: Could you please help to identify the invalid codes for medicare Annual Wellness Visits?

Helen:

Q and G PAP codes are not billable when an E/M visit is billed. It is considered part of the E/M service.

Subject: Could you please help to identify the invalid codes for medicare Annual Wellness Visits?To: "IMP Group" <practiceimprovement1 >Date: Thursday, January 26, 2012, 9:31 AM

Dear all,I had never billed Medicare the breast exam and Pap smear codes before for the GYN annuals we had done before. Tried for the first time yesterday, but bounced back by the clearing house under "invalid procedure codes" (but it did not indicate which one was invalid). Could you please help to take a look which one is wrong? I first wondered if the clearing house made a mistake, but same "invalid codes" messages showed on 3 other medicare annual claims too this week.For a female GYN annual + EM: G0439 --------------

V72.31 99214 -25 ------- 250.02, 401.1, 272.4, 733.09 G0101---------------

V72.31 Q0091----------------V72.31For a male pt annual: G0439 ------------ V70.0 99213 -25-------- 272.4, 600.00, 268.9, 477.9Would you please let me know how to make the corrections? Thank you very much in advance.Helen

[Guest guest]

Thank you all for your kind help.HelenTo: From: carlygold@...Date: Fri, 27 Jan 2012 08:44:40 -0800Subject: Re: Could you please help to identify the invalid codes for medicare Annual Wellness Visits?

Actually you can bill pap and pelvic/CBE WITH an E & M service and the frequency of the pap depends on the risk of the patient. Medicare will pay for a yearly pap for high risk women. Medicare considers a woman at high risk if she:• Is of childbearing age; • Has a prior history of cancer or sexually transmitted disease; • Has been infected with human papilloma viruses (HPVs). • Had an abnormal Pap smear within the past three years; • Began having sexual intercourse before age 16; • Has had more than five sexual partners; • Has not had a Pap smear within seven years; and/or • Has a mother who used diethylstilbestrol (DES) during

pregnancy.Otherwise, they pay every two years.For men, you CANNOT bill for a DRE with an E & M code. RE: what diagnosis code to use with the AWV, this is direct from CMS questions/answers: "A

diagnosis code must be reported, however, CMS does not require a specific diagnosis code for the Annual Wellness Visit (AWV). Therefore, providers can choose any appropriate diagnosis code."I'm guessing that you might have been denied because these patients never had their initial AWV billed- if they were your patients in 2011 and you didn't do it, then it wasn't done unless they went to someone else just for that. My understanding is the subsequent visit will be denied if the initial has never been billed. We are now into the second year of AWVs as of 1/1/12 ... during all of 2011 only the G0438 code could be billed... now, one can bill the G0439 IF the G0438 has been billed once for that patient already.. at least 12 months previously.Here is an older guide to billing preventive services- it does not address the new

AWVs or IPPEhttp://www.acponline.org/running_practice/practice_management/payment_coding/medicare/pb_coding.pdfHere is a short blurb from Medicare that is helpful: http://www.cms.org/uploads/NewMedicarePreventiveServices.pdfHelen, keep after it- it is well worth it!Carla To:

Sent: Thursday, January 26, 2012 3:00 PM Subject: Re: Could you please help to identify the invalid codes for medicare Annual Wellness Visits?

Helen:

Q and G PAP codes are not billable when an E/M visit is billed. It is considered part of the E/M service.

Subject: Could you please help to identify the invalid codes for medicare Annual Wellness Visits?To: "IMP Group" <practiceimprovement1 >Date: Thursday, January 26, 2012, 9:31 AM

Dear all,I had never billed Medicare the breast exam and Pap smear codes before for the GYN annuals we had done before. Tried for the first time yesterday, but bounced back by the clearing house under "invalid procedure codes" (but it did not indicate which one was invalid). Could you please help to take a look which one is wrong? I first wondered if the clearing house made a mistake, but same "invalid codes" messages showed on 3 other medicare annual claims too this week.For a female GYN annual + EM: G0439 --------------

V72.31 99214 -25 ------- 250.02, 401.1, 272.4, 733.09 G0101---------------

V72.31 Q0091----------------V72.31For a male pt annual: G0439 ------------ V70.0 99213 -25-------- 272.4, 600.00, 268.9, 477.9Would you please let me know how to make the corrections? Thank you very much in advance.Helen

[Guest guest]

I havn't got Medicare reimbursed any CLIA waived test done in office, and I have a CLIA waiver certificate.

 

CPT 82270, - BLOOD, OCCULT, BY PEROXIDASE ACTIVITY, QUALITATIVE; FECES, 1-3 SIMULTANEOUS DETERMINATIONS. I don't bill for a DRE with an E & M code. Has anyone get reimbursed for doing Occult blood? Is it necessary to put a modifier?

 

CPT 82948 - GLUCOSE; BLOOD, REAGENT STRIP. In office check for a diabetic patient.

 

CPT 81002 - URNLS DIP STICK/TABLET RGNT NON-AUTO W/O MIC, patient came in with UTI symptoms.

 

The amount isn't big. But these could be recurrent tests. Any help is appreciated.

 

Thank you.

Wen

 

 

Actually you can bill pap and pelvic/CBE WITH an E & M service and the frequency of the pap depends on the risk of the patient. Medicare will pay for a yearly pap for high risk women. 

Medicare considers a woman at high risk if she:•    Is of childbearing age; •    Has a prior history of cancer or sexually transmitted disease; •    Has been infected with human papilloma viruses (HPVs). •    Had an abnormal Pap smear within the past three years; •    Began having sexual intercourse before age 16; •    Has had more than five sexual partners; •    Has not had a Pap smear within seven years; and/or •    Has a mother who used diethylstilbestrol (DES) during pregnancy.

Otherwise, they pay every two years.

For men, you CANNOT bill for a DRE with an E & M code.

RE: what diagnosis code to use with the AWV, this is direct from CMS questions/answers: " A diagnosis code must be reported, however, CMS does not require a specific diagnosis code for the Annual Wellness Visit (AWV). Therefore, providers can choose any appropriate diagnosis code. "

I'm guessing that you might have been denied because these patients never had their initial AWV billed- if they were your patients in 2011 and you didn't do it, then it wasn't done unless they went to someone else just for that. My understanding is the subsequent visit will be denied if the initial has never been billed. We are now into the second year of AWVs as of 1/1/12 ... during all of 2011 only the G0438 code could be billed... now, one can bill the G0439 IF the G0438 has been billed once for that patient already.. at least 12 months previously.

Here is an older guide to billing preventive services- it does not address the new AWVs or IPPE

http://www.acponline.org/running_practice/practice_management/payment_coding/medicare/pb_coding.pdf

Here is a short blurb from Medicare that is helpful:  http://www.cms.org/uploads/NewMedicarePreventiveServices.pdf

Helen,  keep after it- it is well worth it!

Carla

To:

Sent: Thursday, January 26, 2012 3:00 PMSubject: Re: Could you please help to identify the invalid codes for medicare Annual Wellness Visits?

 

Helen:

 

Q and G PAP codes are not billable when an E/M visit is billed.  It is considered part of the E/M service.

 

Subject: Could you please help to identify the invalid codes for medicare Annual Wellness Visits?

To: " IMP Group " <practiceimprovement1 >Date: Thursday, January 26, 2012, 9:31 AM

 

Dear all,I had never billed Medicare the breast exam and Pap smear codes before for the GYN annuals we had done before. Tried for the first time yesterday, but bounced back by the clearing house under " invalid procedure codes " (but it did not indicate which one was invalid). 

Could you please help to take a look which one is wrong? I first wondered if the clearing house made a mistake, but same " invalid codes " messages showed on 3 other medicare annual claims too this week.

For a female GYN annual + EM:              G0439 -------------- V72.31                                                             99214  -25  ------- 250.02, 401.1, 272.4, 733.09                                                             G0101--------------- V72.31

                                                             Q0091----------------V72.31For a male pt annual:    G0439 ------------ V70.0                                    99213  -25-------- 272.4, 600.00, 268.9, 477.9

Would you please let me know how to make the corrections?  Thank you very much in advance.Helen

[Guest guest]

Wen, Hi! It took me 8 months, 5-6 calls to my Medicare carrier, 2 calls to my

electronic billing company (EZ Claims), and reading a lot of postings by

Pratt to get Medicare to pay me consistently for my in-office, CLIA-waived

labs!! So, DO NOT GIVE UP and let them cheat you out of money you have earned

by taking good care of your patients, as I know some other docs have done! I

have saved these hints to repost whenever a new person runs into this problem:

1) If you do an E & M the same day, always put a -25 modifier on the E & M code.

2) Make sure that the diagnosis code that is linked to the test code

justifies the test, such as " dysuria " for a U/A.

3) Put the QW (CLIA waived) modifier after the test code for rapid Strep,

rapid influenza, and mono tests. DO NOT put the QW modifier on U/A, urine HCG,

blood glucose, and fecal OB, or they may not pay! My carrier denied some because

I put it on unnecessarily, thinking that all CLIA-waived labs might need it.

(Silly me!)

4) Your CLIA registration number must be on the bill (for Medicare only;

other insurers don't seem to need it.) On the CMS 1500 form, it goes on line 23,

which says " Prior Authorization Number. " If you use electronic billing, be sure

to check with your vendor about how to get it to show up there, since it may not

be intuitive, as it wasn't in my case.

5) Enter yourself as the referring/ordering provider on line 17 of the CMS

1500 form, with your individual NPI on line 17a.

If you do ALL THESE THINGS, and the moon is not full, and the month doesn't end

in " R, " they will probably pay you! If they don't, call your carrier with an

individual claim and get them to tell you why. If the person you talk to first

can't tell you, ask nicely to speak to their supervisor. Do not give up until

it works. In the meantime, keep a record of all the ones that are denied, so

that, once you have it figured out, you can go back and rebill them all and get

paid. That's what I did, after 8 months. Those $3 payments tasted very

sweet...!---Sharlene---

> >

> >

> >

> > Subject: Could you please help to identify the

> > invalid codes for medicare Annual Wellness Visits?

> > To: " IMP Group " <practiceimprovement1 >

> > Date: Thursday, January 26, 2012, 9:31 AM

> >

> >

> > Dear all,

> >

> > I had never billed Medicare the breast exam and Pap smear codes before for

> > the GYN annuals we had done before. Tried for the first time yesterday, but

> > bounced back by the clearing house under " invalid procedure codes " (but it

> > did not indicate which one was invalid).

> >

> > Could you please help to take a look which one is wrong? I first wondered

> > if the clearing house made a mistake, but same " invalid codes " messages

> > showed on 3 other medicare annual claims too this week.

> >

> > For a female GYN annual + EM: G0439 -------------- V72.31

> > 99214 -25

> > ------- 250.02, 401.1, 272.4, 733.09

> >

> > G0101--------------- V72.31

> >

> > Q0091----------------V72.31

> >

> > For a male pt annual: G0439 ------------ V70.0

> > 99213 -25-------- 272.4, 600.00,

> > 268.9, 477.9

> >

> > Would you please let me know how to make the corrections? Thank you very

> > much in advance.

> >

> > Helen

> >

> >

> >

> >

> >

>

[Guest guest]

Yes a modifier is required it is QW. If you are doing your billing you can call the " Medicare telephone reopening" number and tell them all the dates of service that you need to add that modifier to. Do not rebill!!! They will deny. You must call. You can try this number but it might only be for a few west coast states. . I make my modifiers automatically default and erase them if they are not a medicare patient, just because I cannot seem to remember. lol Michele From: Wen Liang

To: Sent: Friday, January 27, 2012 9:50 AM Subject: Re: Could you please help to identify the invalid codes for medicare Annual Wellness Visits?

I havn't got Medicare reimbursed any CLIA waived test done in office, and I have a CLIA waiver certificate.

CPT 82270, - BLOOD, OCCULT, BY PEROXIDASE ACTIVITY, QUALITATIVE; FECES, 1-3 SIMULTANEOUS DETERMINATIONS. I don't bill for a DRE with an E & M code. Has anyone get reimbursed for doing Occult blood? Is it necessary to put a modifier?

CPT 82948 - GLUCOSE; BLOOD, REAGENT STRIP. In office check for a diabetic patient.

CPT 81002 - URNLS DIP STICK/TABLET RGNT NON-AUTO W/O MIC, patient came in with UTI symptoms.

The amount isn't big. But these could be recurrent tests. Any help is appreciated.

Thank you.

Wen

Actually you can bill pap and pelvic/CBE WITH an E & M service and the frequency of the pap depends on the risk of the patient. Medicare will pay for a yearly pap for high risk women.

Medicare considers a woman at high risk if she:• Is of childbearing age; • Has a prior history of cancer or sexually transmitted disease; • Has been infected with human papilloma viruses (HPVs). • Had an abnormal Pap smear within the past three years; • Began having sexual intercourse before age 16; • Has had more than five sexual partners; • Has not had a Pap smear within seven years; and/or • Has a mother who used diethylstilbestrol (DES) during pregnancy.

Otherwise, they pay every two years.

For men, you CANNOT bill for a DRE with an E & M code.

RE: what diagnosis code to use with the AWV, this is direct from CMS questions/answers: "A diagnosis code must be reported, however, CMS does not require a specific diagnosis code for the Annual Wellness Visit (AWV). Therefore, providers can choose any appropriate diagnosis code."

I'm guessing that you might have been denied because these patients never had their initial AWV billed- if they were your patients in 2011 and you didn't do it, then it wasn't done unless they went to someone else just for that. My understanding is the subsequent visit will be denied if the initial has never been billed. We are now into the second year of AWVs as of 1/1/12 ... during all of 2011 only the G0438 code could be billed... now, one can bill the G0439 IF the G0438 has been billed once for that patient already.. at least 12 months previously.

Here is an older guide to billing preventive services- it does not address the new AWVs or IPPE

http://www.acponline.org/running_practice/practice_management/payment_coding/medicare/pb_coding.pdf

Here is a short blurb from Medicare that is helpful: http://www.cms.org/uploads/NewMedicarePreventiveServices.pdf

Helen, keep after it- it is well worth it!

Carla

To:

Sent: Thursday, January 26, 2012 3:00 PMSubject: Re: Could you please help to identify the invalid codes for medicare Annual Wellness Visits?

Helen:

Q and G PAP codes are not billable when an E/M visit is billed. It is considered part of the E/M service.

Subject: Could you please help to identify the invalid codes for medicare Annual Wellness Visits?

To: "IMP Group" <practiceimprovement1 >Date: Thursday, January 26, 2012, 9:31 AM

Dear all,I had never billed Medicare the breast exam and Pap smear codes before for the GYN annuals we had done before. Tried for the first time yesterday, but bounced back by the clearing house under "invalid procedure codes" (but it did not indicate which one was invalid).

Could you please help to take a look which one is wrong? I first wondered if the clearing house made a mistake, but same "invalid codes" messages showed on 3 other medicare annual claims too this week.

For a female GYN annual + EM: G0439 -------------- V72.31 99214 -25 ------- 250.02, 401.1, 272.4, 733.09 G0101--------------- V72.31

Q0091----------------V72.31For a male pt annual: G0439 ------------ V70.0 99213 -25-------- 272.4, 600.00, 268.9, 477.9

Would you please let me know how to make the corrections? Thank you very much in advance.Helen

[Guest guest]

Yep, what she said. Although I have never had to put a -25 modifier on my E & M to get the Urine dip paid (only test I do really and Meidcare is one of the last insurances that actually will pay for it.) Kathy Saradarian, MDBranchville, NJwww.qualityfamilypractice.comSolo 4/03, Practicing since 9/90Practice Partner 5/03Low staffing From: [mailto: ] On Behalf Of sharkinnSent: Friday, January 27, 2012 2:18 PMTo: Subject: Re: Could you please help to identify the invalid codes for medicare Annual Wellness Visits? Wen, Hi! It took me 8 months, 5-6 calls to my Medicare carrier, 2 calls to my electronic billing company (EZ Claims), and reading a lot of postings by Pratt to get Medicare to pay me consistently for my in-office, CLIA-waived labs!! So, DO NOT GIVE UP and let them cheat you out of money you have earned by taking good care of your patients, as I know some other docs have done! I have saved these hints to repost whenever a new person runs into this problem: 1) If you do an E & M the same day, always put a -25 modifier on the E & M code. 2) Make sure that the diagnosis code that is linked to the test code justifies the test, such as " dysuria " for a U/A.3) Put the QW (CLIA waived) modifier after the test code for rapid Strep, rapid influenza, and mono tests. DO NOT put the QW modifier on U/A, urine HCG, blood glucose, and fecal OB, or they may not pay! My carrier denied some because I put it on unnecessarily, thinking that all CLIA-waived labs might need it. (Silly me!)4) Your CLIA registration number must be on the bill (for Medicare only; other insurers don't seem to need it.) On the CMS 1500 form, it goes on line 23, which says " Prior Authorization Number. " If you use electronic billing, be sure to check with your vendor about how to get it to show up there, since it may not be intuitive, as it wasn't in my case.5) Enter yourself as the referring/ordering provider on line 17 of the CMS 1500 form, with your individual NPI on line 17a.If you do ALL THESE THINGS, and the moon is not full, and the month doesn't end in " R, " they will probably pay you! If they don't, call your carrier with an individual claim and get them to tell you why. If the person you talk to first can't tell you, ask nicely to speak to their supervisor. Do not give up until it works. In the meantime, keep a record of all the ones that are denied, so that, once you have it figured out, you can go back and rebill them all and get paid. That's what I did, after 8 months. Those $3 payments tasted very sweet...!---Sharlene---> >> >> > > > Subject: Could you please help to identify the> > invalid codes for medicare Annual Wellness Visits?> > To: " IMP Group " <practiceimprovement1 >> > Date: Thursday, January 26, 2012, 9:31 AM> >> >> > Dear all,> >> > I had never billed Medicare the breast exam and Pap smear codes before for> > the GYN annuals we had done before. Tried for the first time yesterday, but> > bounced back by the clearing house under " invalid procedure codes " (but it> > did not indicate which one was invalid).> >> > Could you please help to take a look which one is wrong? I first wondered> > if the clearing house made a mistake, but same " invalid codes " messages> > showed on 3 other medicare annual claims too this week.> >> > For a female GYN annual + EM: G0439 -------------- V72.31> > 99214 -25> > ------- 250.02, 401.1, 272.4, 733.09> >> > G0101--------------- V72.31> >> > Q0091----------------V72.31> >> > For a male pt annual: G0439 ------------ V70.0> > 99213 -25-------- 272.4, 600.00,> > 268.9, 477.9> >> > Would you please let me know how to make the corrections? Thank you very> > much in advance.> >> > Helen> >> >> >> > > >>

[Guest guest]

First obvious question is, are you putting your CLIA # on your claims? And then, are you putting yourself in as the rendering, ordering, and referring provider? Those should cover it!

I havn't got Medicare reimbursed any CLIA waived test done in office, and I have a CLIA waiver certificate.

CPT 82270, - BLOOD, OCCULT, BY PEROXIDASE ACTIVITY, QUALITATIVE; FECES, 1-3 SIMULTANEOUS DETERMINATIONS. I don't bill for a DRE with an E & M code. Has anyone get reimbursed for doing Occult blood? Is it necessary to put a modifier?

CPT 82948 - GLUCOSE; BLOOD, REAGENT STRIP. In office check for a diabetic patient.

CPT 81002 - URNLS DIP STICK/TABLET RGNT NON-AUTO W/O MIC, patient came in with UTI symptoms.

The amount isn't big. But these could be recurrent tests. Any help is appreciated.

Thank you.

Wen

Actually you can bill pap and pelvic/CBE WITH an E & M service and the frequency of the pap depends on the risk of the patient. Medicare will pay for a yearly pap for high risk women.

Medicare considers a woman at high risk if she:• Is of childbearing age; • Has a prior history of cancer or sexually transmitted disease; • Has been infected with human papilloma viruses (HPVs). • Had an abnormal Pap smear within the past three years; • Began having sexual intercourse before age 16; • Has had more than five sexual partners; • Has not had a Pap smear within seven years; and/or • Has a mother who used diethylstilbestrol (DES) during pregnancy.

Otherwise, they pay every two years.

For men, you CANNOT bill for a DRE with an E & M code.

RE: what diagnosis code to use with the AWV, this is direct from CMS questions/answers: "A diagnosis code must be reported, however, CMS does not require a specific diagnosis code for the Annual Wellness Visit (AWV). Therefore, providers can choose any appropriate diagnosis code."

I'm guessing that you might have been denied because these patients never had their initial AWV billed- if they were your patients in 2011 and you didn't do it, then it wasn't done unless they went to someone else just for that. My understanding is the subsequent visit will be denied if the initial has never been billed. We are now into the second year of AWVs as of 1/1/12 ... during all of 2011 only the G0438 code could be billed... now, one can bill the G0439 IF the G0438 has been billed once for that patient already.. at least 12 months previously.

Here is an older guide to billing preventive services- it does not address the new AWVs or IPPE

http://www.acponline.org/running_practice/practice_management/payment_coding/medicare/pb_coding.pdf

Here is a short blurb from Medicare that is helpful: http://www.cms.org/uploads/NewMedicarePreventiveServices.pdf

Helen, keep after it- it is well worth it!

Carla

To:

Sent: Thursday, January 26, 2012 3:00 PMSubject: Re: Could you please help to identify the invalid codes for medicare Annual Wellness Visits?

Helen:

Q and G PAP codes are not billable when an E/M visit is billed. It is considered part of the E/M service.

Subject: Could you please help to identify the invalid codes for medicare Annual Wellness Visits?

To: "IMP Group" <practiceimprovement1 >Date: Thursday, January 26, 2012, 9:31 AM

Dear all,I had never billed Medicare the breast exam and Pap smear codes before for the GYN annuals we had done before. Tried for the first time yesterday, but bounced back by the clearing house under "invalid procedure codes" (but it did not indicate which one was invalid).

Could you please help to take a look which one is wrong? I first wondered if the clearing house made a mistake, but same "invalid codes" messages showed on 3 other medicare annual claims too this week.

For a female GYN annual + EM: G0439 -------------- V72.31 99214 -25 ------- 250.02, 401.1, 272.4, 733.09 G0101--------------- V72.31

Q0091----------------V72.31For a male pt annual: G0439 ------------ V70.0 99213 -25-------- 272.4, 600.00, 268.9, 477.9

Would you please let me know how to make the corrections? Thank you very much in advance.Helen

[Guest guest]

You can always rebill if it was denied. At least in CA, I have never been rejected for a duplicate if the original was denied. You can also submit as "corrected" instead of "original" if you made a mistake and catch it before they process it.

Yes a modifier is required it is QW. If you are doing your billing you can call the " Medicare telephone reopening" number and tell them all the dates of service that you need to add that modifier to. Do not rebill!!! They will deny. You must call. You can try this number but it might only be for a few west coast states. . I make my modifiers automatically default and erase them if they are not a medicare patient, just because I cannot seem to remember. lol Michele From: Wen Liang

To: Sent: Friday, January 27, 2012 9:50 AM Subject: Re: Could you please help to identify the invalid codes for medicare Annual Wellness Visits?

I havn't got Medicare reimbursed any CLIA waived test done in office, and I have a CLIA waiver certificate.

CPT 82270, - BLOOD, OCCULT, BY PEROXIDASE ACTIVITY, QUALITATIVE; FECES, 1-3 SIMULTANEOUS DETERMINATIONS. I don't bill for a DRE with an E & M code. Has anyone get reimbursed for doing Occult blood? Is it necessary to put a modifier?

CPT 82948 - GLUCOSE; BLOOD, REAGENT STRIP. In office check for a diabetic patient.

CPT 81002 - URNLS DIP STICK/TABLET RGNT NON-AUTO W/O MIC, patient came in with UTI symptoms.

The amount isn't big. But these could be recurrent tests. Any help is appreciated.

Thank you.

Wen

Actually you can bill pap and pelvic/CBE WITH an E & M service and the frequency of the pap depends on the risk of the patient. Medicare will pay for a yearly pap for high risk women.

Medicare considers a woman at high risk if she:• Is of childbearing age; • Has a prior history of cancer or sexually transmitted disease; • Has been infected with human papilloma viruses (HPVs). • Had an abnormal Pap smear within the past three years; • Began having sexual intercourse before age 16; • Has had more than five sexual partners; • Has not had a Pap smear within seven years; and/or • Has a mother who used diethylstilbestrol (DES) during pregnancy.

Otherwise, they pay every two years.

For men, you CANNOT bill for a DRE with an E & M code.

RE: what diagnosis code to use with the AWV, this is direct from CMS questions/answers: "A diagnosis code must be reported, however, CMS does not require a specific diagnosis code for the Annual Wellness Visit (AWV). Therefore, providers can choose any appropriate diagnosis code."

I'm guessing that you might have been denied because these patients never had their initial AWV billed- if they were your patients in 2011 and you didn't do it, then it wasn't done unless they went to someone else just for that. My understanding is the subsequent visit will be denied if the initial has never been billed. We are now into the second year of AWVs as of 1/1/12 ... during all of 2011 only the G0438 code could be billed... now, one can bill the G0439 IF the G0438 has been billed once for that patient already.. at least 12 months previously.

Here is an older guide to billing preventive services- it does not address the new AWVs or IPPE

http://www.acponline.org/running_practice/practice_management/payment_coding/medicare/pb_coding.pdf

Here is a short blurb from Medicare that is helpful: http://www.cms.org/uploads/NewMedicarePreventiveServices.pdf

Helen, keep after it- it is well worth it!

Carla

To:

Sent: Thursday, January 26, 2012 3:00 PMSubject: Re: Could you please help to identify the invalid codes for medicare Annual Wellness Visits?

Helen:

Q and G PAP codes are not billable when an E/M visit is billed. It is considered part of the E/M service.

Subject: Could you please help to identify the invalid codes for medicare Annual Wellness Visits?

To: "IMP Group" <practiceimprovement1 >Date: Thursday, January 26, 2012, 9:31 AM

Dear all,I had never billed Medicare the breast exam and Pap smear codes before for the GYN annuals we had done before. Tried for the first time yesterday, but bounced back by the clearing house under "invalid procedure codes" (but it did not indicate which one was invalid).

Could you please help to take a look which one is wrong? I first wondered if the clearing house made a mistake, but same "invalid codes" messages showed on 3 other medicare annual claims too this week.

For a female GYN annual + EM: G0439 -------------- V72.31 99214 -25 ------- 250.02, 401.1, 272.4, 733.09 G0101--------------- V72.31

Q0091----------------V72.31For a male pt annual: G0439 ------------ V70.0 99213 -25-------- 272.4, 600.00, 268.9, 477.9

Would you please let me know how to make the corrections? Thank you very much in advance.Helen

[Guest guest]

I've never put a -25 modifier on. Only QW. And like Kathy said, not always!

Yep, what she said. Although I have never had to put a -25 modifier on my E & M to get the Urine dip paid (only test I do really and Meidcare is one of the last insurances that actually will pay for it.) Kathy Saradarian, MDBranchville, NJwww.qualityfamilypractice.comSolo 4/03, Practicing since 9/90Practice Partner 5/03Low staffing From: [mailto: ] On Behalf Of sharkinnSent: Friday, January 27, 2012 2:18 PMTo: Subject: Re: Could you please help to identify the invalid codes for medicare Annual Wellness Visits? Wen, Hi! It took me 8 months, 5-6 calls to my Medicare carrier, 2 calls to my electronic billing company (EZ Claims), and reading a lot of postings by Pratt to get Medicare to pay me consistently for my in-office, CLIA-waived labs!! So, DO NOT GIVE UP and let them cheat you out of money you have earned by taking good care of your patients, as I know some other docs have done! I have saved these hints to repost whenever a new person runs into this problem: 1) If you do an E & M the same day, always put a -25 modifier on the E & M code. 2) Make sure that the diagnosis code that is linked to the test code justifies the test, such as "dysuria" for a U/A.3) Put the QW (CLIA waived) modifier after the test code for rapid Strep, rapid influenza, and mono tests. DO NOT put the QW modifier on U/A, urine HCG, blood glucose, and fecal OB, or they may not pay! My carrier denied some because I put it on unnecessarily, thinking that all CLIA-waived labs might need it. (Silly me!)4) Your CLIA registration number must be on the bill (for Medicare only; other insurers don't seem to need it.) On the CMS 1500 form, it goes on line 23, which says "Prior Authorization Number." If you use electronic billing, be sure to check with your vendor about how to get it to show up there, since it may not be intuitive, as it wasn't in my case.5) Enter yourself as the referring/ordering provider on line 17 of the CMS 1500 form, with your individual NPI on line 17a.If you do ALL THESE THINGS, and the moon is not full, and the month doesn't end in "R," they will probably pay you! If they don't, call your carrier with an individual claim and get them to tell you why. If the person you talk to first can't tell you, ask nicely to speak to their supervisor. Do not give up until it works. In the meantime, keep a record of all the ones that are denied, so that, once you have it figured out, you can go back and rebill them all and get paid. That's what I did, after 8 months. Those $3 payments tasted very sweet...!---Sharlene---> >> >> > > > Subject: Could you please help to identify the> > invalid codes for medicare Annual Wellness Visits?> > To: "IMP Group" <practiceimprovement1 >> > Date: Thursday, January 26, 2012, 9:31 AM> >> >> > Dear all,> >> > I had never billed Medicare the breast exam and Pap smear codes before for> > the GYN annuals we had done before. Tried for the first time yesterday, but> > bounced back by the clearing house under "invalid procedure codes" (but it> > did not indicate which one was invalid).> >> > Could you please help to take a look which one is wrong? I first wondered> > if the clearing house made a mistake, but same "invalid codes" messages> > showed on 3 other medicare annual claims too this week.> >> > For a female GYN annual + EM: G0439 -------------- V72.31> > 99214 -25> > ------- 250.02, 401.1, 272.4, 733.09> >> > G0101--------------- V72.31> >> > Q0091----------------V72.31> >> > For a male pt annual: G0439 ------------ V70.0> > 99213 -25-------- 272.4, 600.00,> > 268.9, 477.9> >> > Would you please let me know how to make the corrections? Thank you very> > much in advance.> >> > Helen> >> >> >> > > >>

[Guest guest]

Okay, so I studied your emails, and listened to advices. Didn't rebill, confirmed my CLIA # was on the claims.

 

Called Palmettogba ( for Northern CA) and was told CPT 82948 wasn't clia waived. I did an in house glucose finger stick test, what is the CPT code? 

 

To get reimbursed from Medicare for this small amount sounds like Trick or Treat. On the other hand, it is going to be recurring, so it is worth the effort. I image the $2- 3 payment will taste very sweet, Sharlene!

 

Thank you for all your advice.

Wen

 

First obvious question is, are you putting your CLIA # on your claims?  And then, are you putting yourself in as the rendering, ordering, and referring provider?  Those should cover it!

 

I havn't got Medicare reimbursed any CLIA waived test done in office, and I have a CLIA waiver certificate.

 

CPT 82270, - BLOOD, OCCULT, BY PEROXIDASE ACTIVITY, QUALITATIVE; FECES, 1-3 SIMULTANEOUS DETERMINATIONS. I don't bill for a DRE with an E & M code. Has anyone get reimbursed for doing Occult blood? Is it necessary to put a modifier?

 

CPT 82948 - GLUCOSE; BLOOD, REAGENT STRIP. In office check for a diabetic patient.

 

CPT 81002 - URNLS DIP STICK/TABLET RGNT NON-AUTO W/O MIC, patient came in with UTI symptoms.

 

The amount isn't big. But these could be recurrent tests. Any help is appreciated.

 

Thank you.

Wen

 

 

Actually you can bill pap and pelvic/CBE WITH an E & M service and the frequency of the pap depends on the risk of the patient. Medicare will pay for a yearly pap for high risk women. 

Medicare considers a woman at high risk if she:•    Is of childbearing age; •    Has a prior history of cancer or sexually transmitted disease; •    Has been infected with human papilloma viruses (HPVs). •    Had an abnormal Pap smear within the past three years; •    Began having sexual intercourse before age 16; •    Has had more than five sexual partners; •    Has not had a Pap smear within seven years; and/or •    Has a mother who used diethylstilbestrol (DES) during pregnancy.

Otherwise, they pay every two years.

For men, you CANNOT bill for a DRE with an E & M code.

RE: what diagnosis code to use with the AWV, this is direct from CMS questions/answers: " A diagnosis code must be reported, however, CMS does not require a specific diagnosis code for the Annual Wellness Visit (AWV). Therefore, providers can choose any appropriate diagnosis code. "

I'm guessing that you might have been denied because these patients never had their initial AWV billed- if they were your patients in 2011 and you didn't do it, then it wasn't done unless they went to someone else just for that. My understanding is the subsequent visit will be denied if the initial has never been billed. We are now into the second year of AWVs as of 1/1/12 ... during all of 2011 only the G0438 code could be billed... now, one can bill the G0439 IF the G0438 has been billed once for that patient already.. at least 12 months previously.

Here is an older guide to billing preventive services- it does not address the new AWVs or IPPE

http://www.acponline.org/running_practice/practice_management/payment_coding/medicare/pb_coding.pdf

Here is a short blurb from Medicare that is helpful:  http://www.cms.org/uploads/NewMedicarePreventiveServices.pdf

Helen,  keep after it- it is well worth it!

Carla

To:

Sent: Thursday, January 26, 2012 3:00 PMSubject: Re: Could you please help to identify the invalid codes for medicare Annual Wellness Visits?

 

Helen:

 

Q and G PAP codes are not billable when an E/M visit is billed.  It is considered part of the E/M service.

 

Subject: Could you please help to identify the invalid codes for medicare Annual Wellness Visits?To: " IMP Group " <practiceimprovement1 >

Date: Thursday, January 26, 2012, 9:31 AM

 

Dear all,I had never billed Medicare the breast exam and Pap smear codes before for the GYN annuals we had done before. Tried for the first time yesterday, but bounced back by the clearing house under " invalid procedure codes " (but it did not indicate which one was invalid). 

Could you please help to take a look which one is wrong? I first wondered if the clearing house made a mistake, but same " invalid codes " messages showed on 3 other medicare annual claims too this week.

For a female GYN annual + EM:              G0439 -------------- V72.31                                                             99214  -25  ------- 250.02, 401.1, 272.4, 733.09                                                             G0101--------------- V72.31

                                                             Q0091----------------V72.31For a male pt annual:    G0439 ------------ V70.0                                    99213  -25-------- 272.4, 600.00, 268.9, 477.9

Would you please let me know how to make the corrections?  Thank you very much in advance.Helen

[Guest guest]

My understanding is an accucheck is not billable.

We run fasting glucose inthe office on a LDX machine clia waived 82947QW pays between 2-6 dollars depending on insurance.

Subject: Could you please help to identify the invalid codes for medicare Annual Wellness Visits?To: "IMP Group" <practiceimprovement1 >Date:

Thursday, January 26, 2012, 9:31 AM

Dear all,I had never billed Medicare the breast exam and Pap smear codes before for the GYN annuals we had done before. Tried for the first time yesterday, but bounced back by the clearing house under "invalid procedure codes" (but it did not indicate which one was invalid). Could you please help to take a look which one is wrong? I first wondered if the clearing house made a mistake, but same "invalid codes" messages showed on 3 other medicare annual claims too this week.For a female GYN annual + EM: G0439 --------------

V72.31 99214 -25 ------- 250.02, 401.1, 272.4, 733.09 G0101---------------

V72.31 Q0091----------------V72.31For a male pt annual: G0439 ------------ V70.0 99213 -25-------- 272.4, 600.00, 268.9, 477.9Would you please let me know how to make the corrections? Thank you very much in advance.Helen

[Guest guest]

After searching online and calling Medicar:  CPT 82948 is not CLIA waived, but CPT 82962 might be? For glucose finger stick. I will gave one more try, being persistent.

 

Thanks,

Wen

 

My understanding is an accucheck is not billable.

 

 

We run fasting glucose inthe office on a LDX machine clia waived 82947QW pays between 2-6 dollars depending on insurance.

Subject: Could you please help to identify the invalid codes for medicare Annual Wellness Visits?To: " IMP Group " <practiceimprovement1 >

Date: Thursday, January 26, 2012, 9:31 AM

 

Dear all,I had never billed Medicare the breast exam and Pap smear codes before for the GYN annuals we had done before. Tried for the first time yesterday, but bounced back by the clearing house under " invalid procedure codes " (but it did not indicate which one was invalid). 

Could you please help to take a look which one is wrong? I first wondered if the clearing house made a mistake, but same " invalid codes " messages showed on 3 other medicare annual claims too this week.

For a female GYN annual + EM:              G0439 -------------- V72.31                                                             99214  -25  ------- 250.02, 401.1, 272.4, 733.09                                                             G0101--------------- V72.31

                                                             Q0091----------------V72.31For a male pt annual:    G0439 ------------ V70.0                                    99213  -25-------- 272.4, 600.00, 268.9, 477.9

Would you please let me know how to make the corrections?  Thank you very much in advance.Helen

[Guest guest]

Sharlene, thank you for confirming with me. I will send it in a week later. The Medicare person told me not to send in until their system clear a week later. When I get this $3, I will share it with everybody.

Thanks again. Wen

 

Wen, for fingerstick blood glucose, use CPT 82962 " blod glucose by glucose monitoring device specifically cleared by FDA for home use. " ---Sharlene > >>> >>> >>

> >> Subject: Could you please help to identify the> >> invalid codes for medicare Annual Wellness Visits?> >> To: " IMP Group " <practiceimprovement1 >

> >> Date: Thursday, January 26, 2012, 9:31 AM> >>> >>> >> Dear all,> >>> >> I had never billed Medicare the breast exam and Pap smear codes before

> >> for the GYN annuals we had done before. Tried for the first time yesterday,> >> but bounced back by the clearing house under " invalid procedure codes " (but> >> it did not indicate which one was invalid).

> >>> >> Could you please help to take a look which one is wrong? I first wondered> >> if the clearing house made a mistake, but same " invalid codes " messages> >> showed on 3 other medicare annual claims too this week.

> >>> >> For a female GYN annual + EM: G0439 -------------- V72.31> >> 99214 -25> >> ------- 250.02, 401.1, 272.4, 733.09> >>> >> G0101--------------- V72.31

> >>> >> Q0091----------------V72.31> >>> >> For a male pt annual: G0439 ------------ V70.0> >> 99213 -25-------- 272.4, 600.00,> >> 268.9, 477.9

> >>> >> Would you please let me know how to make the corrections? Thank you very> >> much in advance.> >>> >> Helen> >>> >>> >>

> >>> > > >>

[Guest guest]

The fingerstick is just that a finger stick I believe. We billed for it for obtaining blood for the glucose. CMS never paid and some PPO's paid but trivial and so inconsistent was not worth doing, adding code, and then posting on the back end.

Subject: Could you please help to identify the invalid codes for medicare Annual Wellness Visits?To: "IMP Group" <practiceimprovement1 >Date: Thursday, January 26, 2012, 9:31 AM

Dear all,I had never billed Medicare the breast exam and Pap smear codes before for the GYN annuals we had done before. Tried for the first time yesterday, but bounced back by the clearing house under "invalid procedure codes" (but it did not indicate which one was invalid). Could you please help to take a look which one is wrong? I first wondered if the clearing house made a mistake, but same "invalid codes" messages showed on 3 other medicare annual claims too this week.For a female GYN annual + EM: G0439 --------------

V72.31 99214 -25 ------- 250.02, 401.1, 272.4, 733.09 G0101---------------

V72.31 Q0091----------------V72.31For a male pt annual: G0439 ------------ V70.0 99213 -25-------- 272.4, 600.00, 268.9, 477.9Would you please let me know how to make the corrections? Thank you very much in advance.Helen

[Guest guest]

Wen! What  a generous guy! Spread that wealth!:)Jean

 

Sharlene, thank you for confirming with me. I will send it in a week later. The Medicare person told me not to send in until their system clear a week later. When I get this $3, I will share it with everybody.

Thanks again. Wen

--      MD          ph    fax

[Guest guest]

Sounds kind of like a class action suit. Insurance company fined millions of dollars. You will receive $23.16. Thanks Wen. But I think you have earned it. Kathy Saradarian, MDBranchville, NJwww.qualityfamilypractice.comSolo 4/03, Practicing since 9/90Practice Partner 5/03Low staffing From: [mailto: ] On Behalf Of Sent: Saturday, January 28, 2012 8:28 AMTo: Subject: Re: Re: Could you please help to identify the invalid codes for medicare Annual Wellness Visits? Wen! What a generous guy! Spread that wealth! Sharlene, thank you for confirming with me. I will send it in a week later. The Medicare person told me not to send in until their system clear a week later. When I get this $3, I will share it with everybody. Thanks again. Wen -- MD ph fax