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Understanding Medicare yearly Wellness visits

J

Jessica

Guest
What happens when the wellness visit is denied because the visit included an immediate medical need (ie diagnosis of pneumonia)?
 

Alicia Scott

Moderator, CCO Instructor
Staff member
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Blitzer
PBC Student (CPC®)
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ICD-10-CM Student
PPM Student (CPPM®)
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If billing a wellness E/M (99381-99397) there should also be an office visit E/M billed with a 25 modifier.
I obtained this answer from my friend Diana who is a CPC with a remote coding company. I love how coders share information. ;)
 

Alicia Scott

Moderator, CCO Instructor
Staff member
Administrator
Moderator
Blitzer
PBC Student (CPC®)
CCO Club Member
CCO Support Staff
MTA Student
ICD-10-CM Student
PPM Student (CPPM®)
FBC Student (CPC-H®)
From yet another coding friend. :)
I would have to see the exact denial code to comment. Usually when you bill Medicare's Annual Wellness Visits they don't require any specific diagnosis codes but they do recommend you call your Medicare contractor for guidance.

Vanessa Ramirez, CPC CHC
West Texas Medical Associates
Compliance Officer
 
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