Missed Billing Opportunities

The Center of Medicare Services (CMS) is an ever growing and evolving entity and every year it rolls out new changes.  Certain services are added, changed, or removed and it can be a headache to stay on top of the updates.  I recently learned, there were many things I was doing in my daily practice that I did not know I could bill for (listen to more about that on this podcast).

I’d like to shed some light on possible missed opportunities that could increase revenue in the long run.  Keep in mind, however, that these topics revolve around Medicare patients.  What’s best is that the copay and deductible are waived for the patient for all of these services.

The Annual Medicare Exam
G0438 ($174.43), G0439 ($118.21)

These can be billed in addition to a normal office visit if you are addressing acute or chronic conditions, or just doing refills. That means doubling billing, and you will need two separate notes. Another CPT code that can be added is 99497, which is advanced care planning.  Since it’s part of the wellness visit you might as well get compensated for your work.  Also, these are completely covered through Medicare at no cost to the patient.

Alcohol Misuse Screening and Counseling
G0442 for screening ($9.73, 15 minutes) or G0443 for behavior counseling for alcohol misuse ($24.15, 15 minutes)
Depending on your patient population, this might not be applicable, but if you happen to be talking for more than 15 minutes, remember this code.

Smoking Cessation Counseling
99406-3-10 minutes of counseling ($12.61) and 99407 for greater than 10 minutes ($26.31)
The CMS website lists multiple ICD-10 codes that will cover this counseling.  If you’re not doing this already, you should be. The only requirements are that the patient uses tobacco, the patient is competent and alert, and counseling is provided by a qualified physician. You can bill for two separate cessation attempts with each including up to 4 sessions each (for a total of eight in a given year).

Depression Screen
G0444- depression screening, 15 minutes ($9.73)
Screening should be done annually.  If your screening method runs long, please click on the Depression Screen header above for covered ICD-10 codes that may apply.

Intensive Behavioral Therapy for Obesity
G0447 ($24.15)
If weight loss counseling lasts for more than 15 minutes, add on CPT code G0447.  Patient needs to have a BMI over 30.  This can be billed up to 22 times in a year but pay close
attention to the fine print on the CMS website.

Lung Cancer Screening/Counseling
G0296 (27.03)
Low dose CT scan is a great screening tool for patients with a significant smoking history, but did you know that you can bill for the counseling about the CT scan? CPT code G0296 is the
accompanying counseling code when the physician determines the need for the CT scan, usually only done before the first CT scan.  These codes can be billed with a prolonged preventative care add-on.

Prolonged Preventative Services
G0513 for the first 30 minutes ($62.35) and G0514 for each additional 30 minutes ($62.35)
Certain services require this add-on. On the CMS website, codes that require this add-on have a clock
next to it.

Other screening tools that are covered benefits include:

  • Ultrasound screening for Abdominal aortic aneurysm
  • STD screening including Hepatitis B/C, HIV, chlamydia, gonorrhea, and syphilis
  • Cancer screening including screening pelvic/breast exams, mammograms, and PSA/DREs
  • Pneumococcal and influenza vaccination.

Although each code may not seem like it pays a lot, when you multiply each code by the number of
patients to whom they could apply, it may add up to a few thousand dollars of revenue.

Are you making use of all these billing opportunities already?  Are there some that I missed?

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