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Posted By angie on 01-10-2019, 11:50:18 in Ob-Gyn
can we bill following codes with documentation below. pt has medicare
Breast and Pelvic Exam

G0101, breast and pelvic
99213 (gyn issues/rx)
G0447 obesity screening?
G0444, annual depression screening
Comments (1)
Posted By Melanie Witt on 01-10-2019, 15:38:27
First of all, G0447 is not obesity screening, but rather face-to-face behavioral counseling for obesity, 15 minutes and this is not documented in the record you have provided - neither the time spent or the assessment nor the BMI, etc. Go to: https://www.cms.gov/Outreach-and-Education/Medicare-Learning-Network-MLN/MLNMattersArticles/downloads/MM7641.pdf to find the requirements for using this code and the expected documentation.
Second, there is also an article on correct reporting for G0444 at https://www.cms.gov/Outreach-and-Education/Medicare-Learning-Network-MLN/MLNMattersArticles/downloads/MM7637.pdf and this article emphasizes that "Medicare covers annual screening for adults for depression in a primary care setting, as defined below, that has staff-assisted depression care supports in place to assure accurate diagnosis, effective treatment, and follow-up. At a minimum level, staff-assisted depression care supports consist of clinical staff (e.g., nurse, Physician Assistant) in the primary care office who can advise the physician of screening results and who can facilitate and coordinate referrals to mental health treatment. " So if you do not have this type of set-up for these referrals you should not be billing this code. Problematic for me here is that the note shows that the patient denies anxiety or depression in the ROS, and yet she is being treated for anxiety/depression by another clinician so why are you doing the screening (which is only paid for once every 12 months in any case)? In my opinion reporting G0447 and G0444 for this patient is a stretch and I would highly recommend that you look at the coverage criteria before doing so. As you may also know 99213 is bundled into G0101 and G0447 and G0444 are bundled into 99213. The modifier has to go on the bundled code to it would be 99213-25 with G0101, but G0447 and G0444 would need a modifier as they are the bundled codes with 99213. The documentation clearly supports reporting 99213 in addition to G0101.
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