Medical Billing Reimbursement Increase for Screening Exam

The Welcome to Medicare screening exams offer more medical billing reimbursements for medical practices across the country. Currently, if the primary care physician specifically orders any radiology, those tests are chargeable separate from the exam. Make sure you follow Medicare screening rules to ensure you have proper reimbursement.

Typical radiological studies that may be ordered for the Welcome to Medicare exam include a bone mass measurement 76075 (Dual energy x-ray absorptiometry, bone density study, one or more sites; axial skeleton) and a mammogram 76092 ( screening mammography, bilateral two-view film study of each breast). When you use these medical billing current procedural terminology codes, be sure to use the correct diagnosis codes as well.

If you are doing medical billing for a screening mammography, you must use a screening ICD-9 code like V49.81 (Asymptomatic postmenopausal status, age related, natural). However, if the patient present signs or symptoms of osteoporosis, you would not report a screening medical billing CPT code.

One other element to keep in mind when doing medical billing for the Welcome To Medicare Exam is the frequency limitation. Medical billing can only be done within a certain timeframe for different procedures. For example, a bone mass measurement is only allowed once every 24 months for screening purposes. If your medical billing staff bill more often, it will be denied.

Slowly Medicare is transitioning towards allowing more screening types of medical billing. They realize that the more preventative care that is performed, the less they will pay in the long run. For example, it is more beneficial for Medicare to receive medical billing for a screening mammography than months of radiation or chemotherapy. The new Welcome to Medicare screening exam will help your patients and boost your pocketbook when performing medical billing.

View all Articles by: Melissa Clark, CCS-P