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   RE: medicare screening billing
 From: Michael Safran
 To: Member Forum
 Posted: 12-12-2017 10:51
 Message: Melissa,

I have successfully billed EM code with G0101.   My biller insists on using the -25 modifier with the EM code.   I am not sure it is absolutely necessary to add the modifier but will not argue with success.

In my experience, the two main reasons G0101 is not covered are either it is not 2 years since I last billed or another provider billed for it unbeknownst to me, such as GYN, breast surgeon, oncologist, etc.

G0101 is supposed to be reimbursed annually if you use a Hi risk diagnosis code.  I found this link for CMS policies on screening pelvic and breast exam and correct diagnosis and Hi-Risk diagnosis - see page 6.   It looks very helpful.

If you rebill the visit, I would link typical medical diagnosis codes to the 99214, such as htn, hld, dm, etc.

Good luck,
Mike S

Michael S. MD
Original Message:
Sent: 12-11-2017 18:34
From: Melissa Weakland
Subject: medicare screening billing

I typically do screening at the AWV but a few patients I catch as catch can.  I've never tried to get paid but this time I did.

I submitted a 99214  for goiter, osteoporosis and anxiety
and then GO101 with Z12.39 for breast screening

I got paid zero for entire visit.

I realize I did also attach  z12.39 to the 99214
The reason for denial was service /procedure requires a qualifying service/ procedure. B15

Not sure what that means.
 I'm thinking attach z12.39 only to the G0101 and try resubmitting or I'll go back to just billing the -14 and resubmit without the G0101.

If anyone can show me how they would submit billing for this and get paid I'd appreciate it.

Melissa Weakland MD
Ballard Neighborhood Doctors
Seattle WA
IMP since 2007

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