Don't have a TCI SuperCoder account yet? Become a Member >>

Regular Price: $24.95

Ask An Expert Starting at $24.95
Have a medical coding or compliance question? Don’t sacrifice your valuable time to endless research. Choose Ask an Expert to get clear answers from the TCI SuperCoder team. And here’s a tip for the budget-conscious: Select the 12-question pack to get the best rate per question!

Browse Past Questions By Specialty

+View all

What is the new "G" code for Medical Physical Exams?

Diane Posted Mon 24th of January, 2011 18:05:11 PM

I am aware that Medicare now covers Physical Exams (Preventative) every 3 years but what is the new "G" code for these exams? They will deny any claims submitted with V70.0

-Rochelle Pepa, MA for Diane Combs, MD

SuperCoder Answered Tue 25th of January, 2011 05:54:12 AM

You should bill for the physical exam with G0402 (Initial preventive physical examination; face-to-face visit, services limited to new beneficiary during the first six months of Medicare enrollment)

EKG: The “Welcome” physical includes an EKG, so you must also report the appropriate G code for that service, depending on what portion of the EKG your provider performs. Choose from:

• G0403 (Electrocardiogram, routine ECG with at least 12 leads; with interpretation and report, performed as a component of the initial preventive physical examination) with interpretation and report

• G0404 (…tracing only, without interpretation and report, performed as a component of the initial preventive physical examination)

• G0405 (…interpretation and report only, performed as a component of the initial preventive physical examination)

Diagnosis: Because this exam is a preventive visit, you should link diagnosis code V70.0 (Routine general medical examination at a healthcare facility) to justify the service.

Hope this helps..

SuperCoder Answered Tue 25th of January, 2011 10:45:12 AM

Adding another dimension to the answer:

The Affordable Care Act (ACA) extended preventive coverage to more than 88 million patients covered by health insurance, and Medicare has codified that benefit in the form of an annual wellness visit. Medicare valued the new annual wellness codes based on a level 4, problem-oriented new and established E/M service. The two new codes are:
G0438 – Annual wellness visit; includes a personalized prevention plan of service (PPPS), first visit
G0439 – Annual wellness visit; includes a personalized prevention plan of service (PPPS), subsequent visit.

Tip 1: Apply G0438 to Second Year of Coverage
Be wary of applying these codes to new Medicare patients coming in to your physician’s practice in 2011.
The reason is that Medicare will only reimburse the initial visit (G0438) during the second year the patient is eligible for Medicare Part B. In other words, during the first year of the patient’s coverage, Medicare will only cover the Initial Preventive Physical Exam (IPPE), also known as the Welcome to Medicare exam.

Tip 2: CMS Limits G0438 to One Physician
If your FP sees the patient for the initial visit (G0438) and the patient sees a different physician for the next annual wellness visit, that second physician will only receive reimbursement for the subsequent visit (G0439), despite having never seen the patient before.

CMS has indicated that when a patient returns to the same or new physician in a third year, they might only pay for the subsequent visit. It is therefore important that you convey this information to any new physician the patient sees.

Related Topics