Three Visit Types, Three Sets of Requirements
By Jacqueline Nash Bloink, MBA, CPC-I, CHC
There are three types of wellness visits, each of which has different requirements. To know if you are being compliant with requirements and coding correctly, know what each entails:
1. Initial Preventive Physical Examination (IPPE) or the “welcome to Medicare preventive visit” – use code G0402 Initial preventive physical examination; face-to-face visit, services limited to new beneficiary during the first 12 months of Medicare enrollment to describe this service. The beneficiary can only receive this visit during the first year that he or she is eligible and enrolled in Medicare. If the patient does not exercise his or her right to request this visit during that first year, he or she will never again have the chance to request it.
During this visit, the beneficiary is eligible for a screening electrocardiogram (EKG) (G0403-G0405) and aortic aneurysm ultrasound (AAU), if he or she meets the following requirements:
- Patients may be eligible for the screening EKG if a referral is given during the welcome to Medicare preventive visit (G0402) or the EKG is performed during this visit.
- AAU is provided as a one-time screening if the beneficiary gets a referral as a result of the welcome to Medicare preventive visit (G0402), has never had an AAU under the Medicare program, and meets certain eligibility requirements. An eligible patient is one who: (1) has a family history of abdominal aortic aneurysm, or (2) is a male, aged 65-75, who has smoked at least 100 cigarettes during his lifetime, or (3) has other risk factors recommended for ultrasound screening as specified by the national coverage determination process.
For more detail on the EKG and AAU screenings, visit the CMS website.
2. Initial Medicare Annual Wellness Visit (AWV) – After 11 full months have passed, the beneficiary is eligible for the next preventive visit, initial “annual wellness visit.” Use code G0438 Annual wellness visit; includes a personalized prevention plan of service (PPS), initial visit to report this. This visit can be performed at any point in the beneficiary’s life, but only once during his or her lifetime. This code was implemented by CMS in 2011.
3. Subsequent AWV – After 11 full months have passed since the initial wellness visit, the beneficiary is eligible for the “subsequent wellness visit” described by code G0439 Annual wellness visit, includes a personalized prevention plan of service (PPS), subsequent visit. A beneficiary can request this visit every year (after 11 full months have passed between visits), if so desired.
You can find a summary of the requirements of all Medicare wellness visits on the CMS website.