Coders: Annual Wellness Visit--Read the Guidelines!!

[Pam Brooks]

I have seen many threads on this topic that worry me...

Coders, I urge you to make sure you carefully read the MLN Matters MM7079 and the related CR Transmittal R134BP and R2109CP.

I see a lot of you using the words "Annual Physical", or "Preventive Physical". The Annual Wellness Visit is not a head-to-toe physical exam. This is a risk assesment to help physicians put together a patient-specific plan for preventive care. Physicians need to know exactly what criteria are expected for this high-RVU visit. It's up to us, as certified coders to make sure our physicans have the tools and information they need so that they can complete this visit with the appropriate documentation. Believe me, Medicare is going to be auditing this.

The press has erroneously reported that Medicare is now paying for preventive physicals or preventive exams, and our Medicare population is going to be calling your offices, asking for their 'free physical'. Based on the criteria for this covered service, the only objective portion of this encounter is the gathering of vitals. Let's not compound the problem by using the wrong language when describing these services. It will be up to us to educate the patients and our providers that this is not a physical exam, as would be reported by codes in the 99381-99397 range.

[Cpeterson2010]

Thanks for your information Pam.

What is your opinion to using this new code "G0438 and the G0439 along with the G0101 on the same days visit; and could you use a modifier?? Will the providers have to do these on separate visits to be sure they are reimbursed correctly?
Also, any type of sick visit I would guess we could use the modifier 25 on say a 99213 on the same day as a G0438 or G0439 if this should happen to take place on the same day?

Any coder's input would be appreciated! Thanks CP

[LindaEV]

Originally Posted by Cpeterson2010

Thanks for your information Pam.

What is your opinion to using this new code "G0438 and the G0439 along with the G0101 on the same days visit; and could you use a modifier?? Will the providers have to do these on separate visits to be sure they are reimbursed correctly?
Also, any type of sick visit I would guess we could use the modifier 25 on say a 99213 on the same day as a G0438 or G0439 if this should happen to take place on the same day?

Any coder's input would be appreciated! Thanks CP

You can use the G codes on the same day (no modifier needed). Also applies to a sick visit...and yes you would add a -25 on that one.

[Lisa Bledsoe]

Originally Posted by Pam Brooks

I have seen many threads on this topic that worry me...

Coders, I urge you to make sure you carefully read the MLN Matters MM7079 and the related CR Transmittal R134BP and R2109CP.

I see a lot of you using the words "Annual Physical", or "Preventive Physical". The Annual Wellness Visit is not a head-to-toe physical exam. This is a risk assesment to help physicians put together a patient-specific plan for preventive care. Physicians need to know exactly what criteria are expected for this high-RVU visit. It's up to us, as certified coders to make sure our physicans have the tools and information they need so that they can complete this visit with the appropriate documentation. Believe me, Medicare is going to be auditing this.

The press has erroneously reported that Medicare is now paying for preventive physicals or preventive exams, and our Medicare population is going to be calling your offices, asking for their 'free physical'. Based on the criteria for this covered service, the only objective portion of this encounter is the gathering of vitals. Let's not compound the problem by using the wrong language when describing these services. It will be up to us to educate the patients and our providers that this is not a physical exam, as would be reported by codes in the 99381-99397 range.

You are absolutely correct Pam! These new "services" are not physicals in any way shape or form. The only "hands on" required are vitals.

[Pam Brooks]

Originally Posted by Cpeterson2010

Thanks for your information Pam.

What is your opinion to using this new code "G0438 and the G0439 along with the G0101 on the same days visit; and could you use a modifier?? Will the providers have to do these on separate visits to be sure they are reimbursed correctly?
Also, any type of sick visit I would guess we could use the modifier 25 on say a 99213 on the same day as a G0438 or G0439 if this should happen to take place on the same day?

Any coder's input would be appreciated! Thanks CP

Our contractor NHIC hasn't yet come out with the guidelines for those scenarios....in fact, we're still waiting for our 2011 preventive care criteria!

Because the G0101, G0102 and Q0091 are 'separately identifiable' from the G0438 and
G0439, I anticipate that we will be able to bill them as long as we appent the -25 on the
G0438/9.

What I do know about billing the E&M at the same time (i.e 99213) is that the documentation criteria for the AWV includes a great deal of PFSH, and we would not be able to double-dip to use that information to also support an E&M. Basically, anything covered in the AWV could not be considered in a separate E&M...which might limit our higher-level E&M visits. We couldn't count vitals as part of our E&M exam, for example.
Although CMS might not come out with crystal-clear guidlelines regarding these new codes, we can pay attention to the guidelines that are currently in place and use them accordingly for this circumstance.

Pam

[dawnsilva]

according to the Medicare Claims Processing Manual Chapter 12, section 30.6.1.1 under 2. Annual Wellness Visit, it states "allows for a preventive physical exam, called the annual wellness visit".

[Pam Brooks]

Yes, and there lies the problem....even CMS is contradicting themselves.

[dawnsilva]

Not quite sure how is it a contradiction if this is what CMS is stating the wellness visit is?

[brake]

I'm trying to educate my providers and staff; are there any forms or checklist to prompt questions to the patients from the providers so the documentation will be correctly indentified by the criteria? Thanks


Chiquita S. Brake,CPC

[pglazener]

I just want to clarify to make sure I understand the new codes.

If a patient has had their IPPE and is an established patient with a doctor, we would use G0439 for their subsequent AWV as long as it's 12 months after the IPPE.

If a patient has had their IPPE with another doctor and comes to our practice at least 12 months after the date of their IPPE, we would use code G0438.

Is this correct?