Obestity Counseling G0447 with problem visits

Hello,

CMS says G0447 should not be billed with another E&M service on the same day, yet NCCI allows use of modifier on the G0447.

I am confused about this. In what situations would it be okay to unbundle them?

If the patient comes in has a regular f/u visit say for HTN and diabetes, labs checked, meds adjusted as needed, etc. and then the doc does 15 minutes of counseling for the obesity, would that be okay to bill the G0447 with a -59?

Thanks, any input appreciated as well as links to official info if available.

Thanks!

Comments

  • Just trying this again since I didn't get any responses....

    Hello,

    CMS says G0447 should not be billed with another E&M service on the same day, yet NCCI allows use of modifier on the G0447.

    I am confused about this. In what situations would it be okay to unbundle them?

    If the patient comes in has a regular f/u visit say for HTN and diabetes, labs checked, meds adjusted as needed, etc. and then the doc does 15 minutes of counseling for the obesity, would that be okay to bill the G0447 with a -59?

    Thanks, any input appreciated as well as links to official info if available.

    Thanks!
  • Well this is very confusing to me and I think Medicare has gone nuts!!!! A 59 modifier does not belong on an E&M code but yet that is what they are requiring you to use. I know you can do the obesity with IPPE and AWV but their instructions are about as clear as mud.

    DIANA FRANKLIN, CMRS, CPC
    Member American Medical Billing Association
    Member American Academy of Professional Coders
    (931) 879-9854
    dianaf@twlakes.net

  • --94eb2c14ae7af7d188053aec08e3
    Content-Type: text/plain; charset=UTF-8

    Erica did ever get clarity on this? I'm interested myself in a concrete
    answer.

    Thanks
    On Aug 23, 2016 4:21 PM, "Erica Schwalm" <
    Erica.Schwalm@convergentsolutions.com> wrote:

  • edited May 2017
    This is the e-mail I sent to the provider who asked me the question:


    Hello,

    I’ve been researching this topic and my opinion is that you CAN bill for the obesity counseling in addition to another E&M on the same day when appropriate. If the patient came in for a f/u visit for management of other acute or chronic problems and then an additional 15 minutes was spent on the intensive behavioral therapy for obesity, modifier -59 would be appropriate.

    MM7641 says the counseling is not separately payable with another encounter, but that this does not apply for claims that contain modifier -59. I interpret that to mean it can be separately payable if documentation supports using the modifier -59.
    https://www.cms.gov/Outreach-and-Education/Medicare-Learning-Network-MLN/MLNMattersArticles/downloads/MM7641.pdf

    In addition I found this transcript from a National Provider Call that states they can be billed together as long as you meet entirely the requirements for billing both. See page 25. https://www.cms.gov/Outreach-and-Education/Outreach/NPC/Downloads/08-15-12-Transcript.pdf

    Thanks!
    Erica


  • edited May 2017
    CMS and CPT differ many times a good rule of thumb may be to follow CMS guidelines for government payers and CPT guidelines for Commercial payers unless told differently

    Marie Popkin, CPC
    Coding,Consulting & Compliance


Sign In or Register to comment.