Do You Know What an Annual Wellness Visit Is?

Do You Know What an Annual Wellness Visit Is?

Annual Wellness Visits (AWV) are covered by Medicare annually, but they are often confused with other types of examinations, so the Centers for Medicare & Medicaid Services (CMS) has published an MLN booklet to help medical coders and their providers keep them all straight.

Annual Wellness Visit Components

AWVs are only provided annually. The AWV is a visit to perform a health risk assessment (HRA) and develop or update a personalized prevention plan.  To be covered, the Medicare beneficiary must have been covered by Part B for more than 12 months. And they cannot have received an AWV or Initial Preventive Physical Examination (IPPE) within the last 12 months. The IPPE differs in that it’s a review of the beneficiary’s medical and social health history, and includes preventive services education.  To be able to bill for an AWV the provider should fulfill these steps the first time a patient has an AWV:

  • Perform an HRA
  • Establish the beneficiary’s medical and family history
  • Establish a list of current providers and suppliers
  • Measure height, weight, BMI, and blood pressure
  • Detect any cognitive impairment the beneficiary may have
  • Review the beneficiary’s potential risk factors for depression, including current or past experiences with depression or other mood disorders
  • Review the beneficiary’s functional ability and level of safety
  • Establish an appropriate written screening schedule for the beneficiary. CMS recommends a checklist for five to 10 years
  • Establish a list of risk factor and condition for which primary, secondary, or tertiary interventions are recommended or already underway
  • Furnish the beneficiary personalized health advice and appropriate referrals to health education or preventive counseling services or programs
  • At the beneficiary’s discretion, furnish advance care planning services

In subsequent years, the provider should follow these steps:

  • Review and update the HRA
  • Update the beneficiary’s medical/family history
  • Update the list of current providers and suppliers
  • Measure height, weight, BMI, and blood pressure
  • Detect any cognitive impairment
  • Update the written screening schedule
  • Update the list of risk factors and conditions
  • Furnish the beneficiary’s health advices and referral to health education and counseling programs
  • At the beneficiary’s discretion, furnish advance care planning services

Coding Annual Wellness Visits

In addition to the appropriate diagnosis codes, report the following HCPCS Level II codes:

G0438 Annual wellness visit; includes a personalized prevention plan of service (PPS), initial visit
G0439 Annual wellness visit, includes a personalized prevention plan of service (PPS), subsequent visit
G0468 Federally qualified health center (FQHC) visit, IPPE or AWV; a FQHC visit that includes an initial preventive physical examination (IPPE) or annual wellness visit (AWV) and includes a typical bundle of Medicare-covered services that would be furnished per diem to a patient receiving an IPPE or AWV

Reporting  G0468 and FQHC can be hairy, and it’s best to review the Medicare Claims Process Manual, Chapter 9, Section 60.2, when doing so.

What is Macra

And don’t restrict reporting an AWV to a single type of provider. CMS covers an AWV is performed by a physician (MD or DO); qualified non-physician practitioner (PA, NP, and others); or a medical professional, such as a health educator, registered dietitian, nutrition profession , or another licensed practitioner, so long as they are directly supervised by a medical professional.

 

 

Brad Ericson

Brad Ericson

Director of Publishing at AAPC
Brad Ericson, MPC, CPC, COSC, is a seasoned healthcare writer and editor.He directed publishing at AAPC for nearly 12 years and worked at Ingenix for 13 years and Aetna Health Plans prior to that. He has been writing and publishing about healthcare since 1979. He received his Bachelor's in Journalism from Idaho State University and his Master's of Professional Communication degree from Westminster College of Salt Lake City.
Brad Ericson

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About Has 394 Posts

Brad Ericson, MPC, CPC, COSC, is a seasoned healthcare writer and editor. He directed publishing at AAPC for nearly 12 years and worked at Ingenix for 13 years and Aetna Health Plans prior to that. He has been writing and publishing about healthcare since 1979. He received his Bachelor's in Journalism from Idaho State University and his Master's of Professional Communication degree from Westminster College of Salt Lake City.

One Response to “Do You Know What an Annual Wellness Visit Is?”

  1. A. Heiman says:

    When doing a AWV, do you only code as a diagnosis’ the conditions that the pt is being treated for? I can’t find an answer to this anywhere. I am also assuming that you never use the Z00 codes with one. Thank you

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