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   RE: Medicare coding
 From: Melissa Weakland
 To: Member Forum
 Posted: 02-23-2017 20:54
 Message: This has been nagging at me and I finally made time to look- 

I've billed -13 with 25 modifier (paid 61.71)  then G0438 for annual wellness (paid 182.42)  then G0101 for pelvic (no modifier and paid 40.71) and Q0091 for pap (no modifier and paid 49.00)

so there it is - doable and paid.

I have discovered modifiers -25 ONLY on the -13 or -14 ; if put on anything else you don't get paid and I don't think a reason really given...

haven't been paid when for breast exam without pelvic.
And have to be very careful age or won't be covered.

Melissa Weakland MD
Ballard Neighborhood Doctors
Seattle WA
IMP since 2007
Original Message:
Sent: 01-23-2017 12:44
From: Michael Safran
Subject: Medicare coding

I find pure Medicare fairly straight forward, re combining E/M codes with the AWV.      Like Melissa, I attach a -25 modifier to the E/M code.  No problem being reimbursed, except when it is only 364 days or less from last AWV.

I didn't think Medicare covered the G codes for pelvic exam at same time as AWV.  If others have found a way, I would like to hear it.    

Medicare Advantage plans are more problematic, since they seem to have their own rules.  

Mike Safran

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