Coding Insights

Q: If a patient refuses to allow the physician to do a component of the Annual Wellness Visit (AWV) can the physician still bill Medicare?

A: Based on the Medicare guidelines, a provider submitting a claim to Medicare Part B for the initial (G0438) or subsequent (G0439) AWV or the Initial Preventive Physical Examination (IPPE, also known as the Welcome to Medicare Visit) (G0402) must complete all elements as required by instructions.

 If a provider does not perform one or more of the elements, he/she did not perform the complete service and therefore cannot submit the service to Medicare. 

However, check with your local Medicare carrier because some carriers are coming to understand that there are situations when a provider cannot obtain all of the elements – or when all the elements are not medically necessary for each patient.  If a provider makes the determination that an element is not medically appropriate for the patient or if the patient refuses an element of the services, the provider needs to document this information in the medical record. In these situations, the charges can still be submitted to Medicare for reimbursement.

Q:Our organization is concerned about putting resources toward ICD-10 training too early if the date is going to be pushed back again. Can you tell us if the ICD-10 transition date is definite?

A: During a recent eHealth Town Hall, Centers for Medicare and Medicaid Services (CMS) Acting Administrator Marilyn Tavenner confirmed the October 1, 2014, ICD-10 deadline and encouraged everyone to work diligently toward a successful transition. 

CMS is committed to informing and helping the healthcare industry prepare for ICD-10, and is now offering flash drives containing  ICD-10 resources, which are available on CMS’ ICD-10 Web site, www.cms.gov.

Here is an ICD-10 exercise that might help you get ready for the transition

As a continuation of our ICD-10 readiness series, below is an exercise that will help you familiarize yourself with the ICD-10 coding.  Keep in mind that all ICD-10 codes begin with a letter.  In these scenarios, the codes begin with the letter “I.”

Q: A patient was seen today for a follow-up of his benign hypertension.  What is the correct diagnosis code?

A: The correct ICD-10 code is:  I10 (Essential (primary) hypertension.  This code includes: high blood pressure, hypertension (arterial) (benign) (essential) (malignant) (primary) (systemic).  In the ICD-10 coding system, the practitioner will no longer have to document whether the patient’s hypertension is benign or malignant.

Answers to our readers' questions were provided by Erline Franks, CCS-P, CMRS, an associate director at SS&G Healthcare. Send your practice management questions to medec@advanstar.com.