Medical Coding Rights

HCPCS/CPT Codes G0442 – Annual alcohol misuse screening, 15 minutes G0443 – Brief face-to-face behavioral counseling for alcohol misuse, 15 minutes Who Is Covered All Medicare beneficiaries are eligible for alcohol screening. Medicare beneficiaries who screen positive (those who misuse alcohol but whose levels or patterns of alcohol consumption do not meet criteria for alcohol dependence) are eligible for counseling if, They are competent and alert at the time counseling is provided and Counseling is furnished by qualified primary care physicians or other primary care practitioners in a primary care setting Covered ICD Codes F10.282 Alcohol dependence with alcohol-induced sleep disorder F10.288 Alcohol dependence with other alcohol-induced disorder F10.29 Alcohol dependence with unspecified alcohol-induced disorder F10.920 Alcohol use, unspecified with intoxication, uncomplicated F10.921 Alcohol use, unspecified with intoxication delirium F10.929 Alcohol use, unspecified wi

HCPCS/CPT Codes G0102 – Prostate cancer screening; digital rectal examination The Physician performs a prostate cancer screening in which he performs a digital rectal examination to assess the male patient’s prostate.  To examine the prostate the provider inserts a gloved and lubricated finger into the rectum and checks for hardness, lumps, or any abnormalities.  This examination helps detect prostate cancer in its early stages. The provider typically performs this test for the first time at the age of 40 for men at risk of having prostate cancer such as those men with a family history of cancer Medicare provides coverage for an annual prostate cancer screening digital rectal examination for men at the age of 50.   G0103 – Prostate cancer screening; prostate specific antigen test (PSA) The Prostate screening examination, the Physician detects the prostate specific antigen, or PSA, level in a patient’s blood. PSA is a protein the prostate gland produces, and he/she may use PSA levels to

Human Papillomavirus  The lab analyst performs the technical steps to detect human papillomavirus through nucleic acid detection and the Nucleic acid probes permit identification of microorganisms based on their DNA or RNA.  The Nucleic acid quantitation allows assessment of treatment response and the Quantitation refers to measuring the exact amount of a substance. The lab analyst performs this procedure for detection of high risk types of human papillomavirus.  HCPCS/CPT Codes G0476 – Infectious agent detection by nucleic acid (DNA or RNA); human papillomavirus (HPV), high-risk types (eg, 16, 18, 31, 33, 35, 39, 45, 51, 52, 56, 58, 59, 68) for cervical cancer screening, must be performed in addition to pap test  ICD-10 Codes The specified below ICD codes are covered for CPT G0476 but may not be limited and some private payers having specific guidelines. B97.7 Papillomavirus as the cause of diseases classified elsewhere R85.81 Anal high risk human papillomavirus (HPV) DNA test pos

Intensive Behavioral Therapy (IBT) for Cardiovascular Disease (CVD) Also known as a CVD risk reduction visit HCPCS/CPT Codes G0446 – Annual, face-to-face intensive behavioral therapy for cardiovascular disease, individual, 15 minutes Covered ICD Codes The specified below ICD  codes are covered for CPT G0446 but may not be limited and some private payers having specific guidelines. F53.0    Postpartum depression F53.1    Puerperal psychosis  F68.A    Factitious disorder imposed on another I01.0 Acute rheumatic pericarditis I01.1 Acute rheumatic endocarditis I01.2 Acute rheumatic myocarditis I01.8 Other acute rheumatic heart disease I01.9 Acute rheumatic heart disease, unspecified I02.0 Rheumatic chorea with heart involvement I02.9 Rheumatic chorea without heart involvement I05.0 Rheumatic mitral stenosis I05.1 Rheumatic mitral insufficiency I05.2 Rheumatic mitral stenosis with insufficiency I05.8 Other rheumatic mitral valve diseases I05.9 Rheumatic mitral

HCPCS/CPT Codes G0447 – Face-to-face behavioral counseling for obesity, 15 minutes G0473 – Face-to-face behavioral counseling for obesity, group (2–10), 30 minutes Covered ICD-10 Codes for CPT G0447 & G0473 The specified below ICD codes are covered for CPT G0472 and may not be limited and some private payers have own specific guidelines, Z68.30 - Body mass index [BMI] 30.0-30.9, adult Z68.31  -Body mass index [BMI] 31.0-31.9, adult Z68.32 - Body mass index [BMI] 32.0-32.9, adult Z68.33 - Body mass index [BMI] 33.0-33.9, adult Z68.34 - Body mass index [BMI] 34.0-34.9, adult Z68.35 - Body mass index [BMI] 35.0-35.9, adult Z68.36 - Body mass index [BMI] 36.0-36.9, adult Z68.37 - Body mass index [BMI] 37.0-37.9, adult Z68.38 - Body mass index [BMI] 38.0-38.9, adult Z68.39 - Body mass index [BMI] 39.0-39.9, adult Z68.41 - Body mass index [BMI] 40.0-44.9, adult Z68.42 - Body mass index [BMI] 45.0-49.9, adult Z68.43 - Body mass index [BMI] 50.0-59.9, adult Z68.44 - Body mass index [BMI] 6

Screening Pelvic Examinations - Includes a clinical breast examination HCPCS/CPT Codes G0101 – Cervical or vaginal cancer screening; pelvic and clinical breast examination Covered ICD Codes for CPT G0101 The specified below ICD codes are covered for CPT G0472 and may not be limited and some private payers have own specific guidelines, High risk  Z72.51 - High risk heterosexual behavior Z72.52 - High risk homosexual behavior Z72.53 - High risk bisexual behavior Z72.89 - Other problems related to lifestyle Z77.22 - Contact with and (suspected) exposure to environmental tobacco smoke (acute) (chronic) Z77.9 - Other contact with and (suspected) exposures hazardous to health Z91.89 - Other specified personal risk factors, not elsewhere classified Low risk Z01.411-  Encounter for gynecological examination (general) (routine) with abnormal findings Z01.419 -  Encounter for gynecological examination (general) (routine) without abnormal findings Z12.4 -  Encounter for screening for malignant ne

HCPCS/CPT Codes G0472 – Hepatitis C antibody screening, for individual at high risk and other covered indication(s) Covered ICD-10 Codes The specified below ICD codes are covered for CPT G0472 and may not be limited and some private payers have own specific guidelines, B17.10 Acute hepatitis C without hepatic coma B17.11 Acute hepatitis C with hepatic coma B18.2 Chronic viral hepatitis C B18.8 Other chronic viral hepatitis B18.9 Chronic viral hepatitis, unspecified B19.20 Unspecified viral hepatitis C without hepatic coma B19.21 Unspecified viral hepatitis C with hepatic coma B19.9 Unspecified viral hepatitis without hepatic coma B25.1 Cytomegaloviral hepatitis F19.20 Other psychoactive substance dependence, uncomplicated O98.411 Viral hepatitis complicating pregnancy, first trimester O98.412 Viral hepatitis complicating pregnancy, second trimester O98.413 Viral hepatitis complicating pregnancy, third trimester O98.419 Viral hepatitis complicating pregnancy,

Reimbursement Guidelines for Depression Screening - CPT G0444 Depression screening CPT G0444 can't be coded with CPT G0402 & G0438 but you may report with CPT G0439. NCCI edits stated as "Code G0444 is a column 2 code for G0402. You may not override the edit". Details of the CPTs, G0444 - Annual depression screening, 15 minutes G0402 - Initial preventive physical examination; face-to-face visit, services limited to new beneficiary during the first 12 months of Medicare enrollment G0438 - Annual wellness visit; includes a personalized prevention plan of service (PPPS), initial visit Nationally Covered Indications: CMS will cover annual screening up to 15 minutes for Medicare beneficiaries when staff-assisted depression care supports are in place to assure accurate diagnosis, effective treatment, and follow-up.  At a minimum level, staff assisted supports consist of clinical staff (e.g., physician assistant, nurse) in the primary care setting who can advise the physicia