Three codes, one patient, one calendar year, and a denial that cannot be fixed by rebilling. This is the costliest sequencing error in primary care. G0402 — the Welcome to Medicare visit. Once per lifetime, and only within the first 12 months of Part B enrolment. G0438 — the initial Annual Wellness Visit. Once per […]

Read More »

This is the most expensive coding confusion in ABA, and it almost always costs money in the same direction: work done by a BCBA gets paid at technician rates. 97153 is adaptive behavior treatment by protocol. A technician delivers a plan someone else wrote. Technician rate. 97155 is adaptive behavior treatment with protocol modification. A […]

Read More »

Two codes describe the same thing: time you spent on an office visit beyond what the primary E/M code covers. Bill the wrong one to the wrong payer and it denies every time. 99417 is the CPT code. Most commercial payers want it. G2212 is the HCPCS code Medicare created because CMS disagreed with how […]

Read More »

CO-97 reads: “The benefit for this service is included in the payment/allowance for another service or procedure that has already been adjudicated.” In plain terms: the payer decided you already got paid for this. Not that the service was unnecessary. Not that documentation was missing. That it was part of something else on the claim. […]

Read More »