Wiki Annual Medicare Visit with a problem visit on same date of service

[SSweetland]

I am looking for education material to present to the providers on the topic of billing an annual Medicare visit with a problem visit on the same date of service. I informed the provider the problem visit has to be separate identifiable medically necessary E/M service to treat the beneficiary's illness or injury, or to improve the functioning of a malformed body member. The problem I am having is explaining myself when treating Hypertension, hyperlipidemia, (chronic conditions) at the time of the annual visit. Can you please help me gather some information. I have been on CMS website and viewed all information but the only explanation it gives is the statement about medical necessary. Thank you so much in advance
Sheila Sweetland, CPC

 

[annielou]

Medicare Annual Wellness visits

I printed off the information on MAW visits from Medlearn and presented them to our docs. I also explained that since the guidelines did not allow for an actual physical exam, they could charge for the physical exam and review of labs using 99212-99214, but not to allow the time and elements of the AWV in the E/M code. Generally, we end up charging a 99213/25 for the exam and addressing the patient's health issues, as well as reviewing appropriate labs done in advance of the visit.
We use the AWV template to document everthing necessary for Medicare and also include the physical exam and findings within that template.
If appropriate, you can also charge the G0101 for female exams (check the guidelines on the Medicare website) every other year.

 

[rthames052006]

I am looking for education material to present to the providers on the topic of billing an annual Medicare visit with a problem visit on the same date of service. I informed the provider the problem visit has to be separate identifiable medically necessary E/M service to treat the beneficiary's illness or injury, or to improve the functioning of a malformed body member. The problem I am having is explaining myself when treating Hypertension, hyperlipidemia, (chronic conditions) at the time of the annual visit. Can you please help me gather some information. I have been on CMS website and viewed all information but the only explanation it gives is the statement about medical necessary. Thank you so much in advance
Sheila Sweetland, CPC[/QUOT

CMS has information regarding the billing of a separately identifiable E/M on the same day as an AWV. They have a quick reference guide w/ FAQ's

Here is what it states:

Q: Can I bill a separate Evaluation adn Management service at the same visit as the AWV:

A: Medicare may pay for a significant, seprately identifiable, medically necessary E/M service ( 99201-99215) billed at the same visit as the AWV when billed with modifier -25. That portion of the visit must be medically necessary to treat the beneficiary's illness or injury, or to improve the functioning of a malformed body member.

I have always trained my providers to make sure they document a separate note, also if these conditions are stable it throws up a red flag to me to bill for an e/m at the same time as the AWV ( just my opinion).

I tend to think back on the subject of a preventive visit and a problem/acute e/m visit on the same day that states: "If any abormaility is encountered or a preexisting probelm is addressed in teh process of performing a preventive medicine evaluation and management service, and if the probelm or abnormality is significant enough to require additional work to perform the key componenets of a problem oriented e/m service, then the appropriate office/outpatient code 99201-99215 should also be reported" ( again this is the logic I use, you do not have to use it but I like to have a rule of thumb for these issues that helps me decipher the information and the necessity).

 

[SSweetland]

Thank you so much for the information and It's always nice to hear an interpretation from another coder. I have read so much about IPPE and AWV that I am overthinking the process.
Sheila Sweetland