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Pam Posted Wed 19th of June, 2013 20:10:27 PM

what modifier IS useD to bill for g0402,
w/ g0444& g0446? I get an error that says g0444 is included w/g0402. this should not be.Medicare allows annual screenings for depression (cpt g0444), cardiovascular (g04446) & obesity (g0447) how should I bill?

SuperCoder Answered Thu 20th of June, 2013 22:04:36 PM

Medicare Contractors will pay claims for G0446 only when services are provided for the following Place of Service (POS):

11-Physician’s Office;

22-Outpatient Hospital;

49-Independent Clinic ; or,

71-State or local public health clinic.

For claims processed on or after April 2, 2012, Medicare will allow payment for G0446 no more than once in a 12-month period.

Medicare will not pay G0446 separately with another encounter/visit when billed on the same day. However, this does not apply to claims with the Initial Preventive Physical Examination (IPPE - HCPCS code G0402) containing modifier 59 or claims containing Diabetes Self-Management Training or Medical Nutrition Training services.

Pam Posted Tue 25th of June, 2013 20:29:24 PM

this doesn't answer my question. does medicare pay for g0402,g0444, g0446 and g0447 when billed together and if so, is a modifier required? all services done at the same visit.

SuperCoder Answered Tue 25th of June, 2013 22:20:13 PM

As per the latest CCI edits

G0402,G0446 and G0447 can be billed together without any modifier. However,

Code G0444 is a column 2 code for g0402, These codes cannot be billed together in any circumstances.
Code G0444 is bundled into code g0402 Code G0444 cannot be billed with g0402.

Pam Posted Thu 27th of June, 2013 20:22:04 PM

thank you , but what do you mean by column 2 for g0402? will medicare pay for g0444 when billed togehter with g0446,g0447 and either g0438 and g0439?

SuperCoder Answered Fri 28th of June, 2013 02:46:45 AM

"will medicare pay for g0444 when billed togehter with g0446,g0447 "-- Answer is yes. They do not bundle with each other.

"and either g0438 and g0439"-- Answer is no.Only G0438 will be coded. The other 2 codes G0444 and G0439 gets bundled into it.

The column 1/column 2 correct coding edit table contains two types of code pair edits. In the "Comprehensive Code" edits table, the column 1 code generally represents the more significant procedure or service when reported with the column 2 code. When reported with the column 2 code, "column 1" generally represents the code with the greater work RVU of the two codes. The "Mutually Exclusive" edit table contains code pairs that Medicare believes should not be reported together where one code is assigned as the column 1 code and the other code is assigned as the column 2 code. If a provider submits two codes of a code pair edit for the same Medicare beneficiary for the same date of service without an appropriate modifier, the column 1 code is paid. If clinical circumstances justify appending a NCCI/CCI-associated modifier to the column 2 code of a code pair edit, payment of both codes may be allowed.

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