New Medicare 'G' Codes

June 16, 2011

Here's some guidance on using the new Medicare G0438 and G0439 codes.

Question: Can I use the new Medicare G0438 and G0439 like I use the older preventive medicine codes 99381-99397? I've been told that I have to do more.

Answer: In some ways you need to do a bit more for annual wellness visits than for the CPT-based preventive codes and in some ways less. The G-codes actually don't include a physical exam, though many providers indicate that they are doing them (Often this is because they are handling problems at the same time as prevention).

The additional work that some providers may not be aware of is related to the personal preventive plan requirement. The two services that require a good bit of work are (according to CMS):

• A written screening schedule for the individual, such as a checklist for the next five to 10 years, as appropriate, based on recommendations of the United States Preventive Services Task Force (USPSTF) and the Advisory Committee on Immunization Practices (ACIP), as well as the individual's health status, screening history, and age-appropriate preventive services covered by Medicare.

• A list of risk factors and conditions for which primary, secondary, or tertiary interventions are recommended or are underway for the individual, including any mental health conditions or any such risk factors or conditions that have been identified through an IPPE, and a list of treatment options and their associated risks and benefits.

I recommend that all providers go to the USPSTF website for the screening elements. This outlines the recommendations by the task force. You may be surprised that these differ somewhat from certain accepted standards. Your best bet is to develop a form to use in your practice to address these two requirements.

Bill Dacey, CPC, MBA, MHA, is principal in the Dacey Group, a consulting firm dedicated to coding, billing, documentation, and compliance concerns. Dacey is a PMCC-certified instructor and has been active in physician training for more than 20 years. He can be reached at billdacey@msn.com or editor@physicianspractice.com.

This article originally appeared in the May 2011 issue of Physicians Practice.