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   RE: Medicare coding
 From: Michael Safran
 To: Member Forum
 Posted: 01-23-2017 12:45
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

------Original Message------

You can use and should be reimbursed for -13 assuming you have ICD-10 to connect to it- i.e. whatever problem you discussed ( atrophic vaginitis or HTN or whatever). Then place -25 modifier on your -13 and use the G code for whatever part of prevention exam you did.

did you do this and not get paid? 

You can also do a Medicare wellness with its g code and then use another appropriate G code for the prevention exam portion.  I found out the hard way no -25 modifier here. If you place it you just won't get paid for that line.

Come to the March call, 1st Wednesday in March- what's that code?   You can ask all these questions or any other code questions and hear what others though the years have figured out.

i think Medicare and procedure coding hugely helpful to share tips. I just learned about proper vaccine coding and now get more than a hundred more dollars a visit because of it. So I'll be on the call. I always glean something most helpful. 

Melissa Weakland MD
Ballard Neighborhood Doctors
Seattle WA
IMP since 2007

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