Wiki Annual and physical visits

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Can a provider start billing CCM one month skip a couple of months and start billing CCM again.
Example CCM bill March didn't contact patient next two months then starts CCM in June bills for June them skips July.
I need help!

elenax

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I need a little understanding if you would on how to bill correctly a wellness visit when a PCP have billed for a full physical exam. Can an Annual wellness visit and a full physical exam be billed on the same date of service for any non-Medicare aged patient?


Thank you,
 

SharonCollachi

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I am unclear as to what would be different between a "wellness visit" and a "full physical exam". I always thought they were the same thing.
 

elenax

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Yes, it is very confusing but they are not the same and below is why. We are getting denials and it is my impression that they just pay for one and not both in a year.

An annual physical typically involves an exam by a doctor along with bloodwork or other tests. The annual wellness visit generally doesn't include a physical exam, except to check routine measurements such as height, weight and blood pressure.

What is a wellness exam? An annual exam is a comprehensive preventative exam with your primary care provider for the sole purpose of preventative care. An annual exam does not include discussion of new problems or detailed review of chronic conditions. Annual exams may also be called routine check-ups, yearly exams, an annual pap, or preventive visit.

Thank you,
 

SharonCollachi

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Okay, so my health insurance (and frankly, every health insurance plan I've ever explored) covers one preventive/wellness/"annual physical" exam per year for adults. My doctors have always combined all of those things into one visit.

Where are the "rules" on what constitutes these two definitions as you have posted here?
 

elenax

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Thank you for your feedback. I found the definitions on the following links:


We got a denial from Florida Blue "PR119: Benefit maximum for this time period or occurrence has been reached" This is the first time the patient has an annual visit with us so we are thinking that perhaps the claim is denying against a PCP claim if she had a physical done on the same period of time and we were not aware.
 

twalls

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I continually run into this! Explaining to providers that Medicare covers only an Annual Wellness Visit which is a "hands off visit" coded with G0438 or G0439, they require paperwork, no cost sharing to the patient, but usually the patient as well as the provider do not want to be bothered with this type of visit. Some Medicare advantage plans (I'm in NY) do cover both Annual Physicals- 99387/99397 and AWV that can be done at the same visit but are very lengthy and trying to get them to both isn't very easy to convince them to do either.
 

twalls

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The link that was referenced was defining the differences between Medicare Wellness and Annual physicals, so I chimed in.
If we are talking non-Medicare what might be happening with the denial, is a patient, most likely a woman, that has had a preventative visit- same code billed but the DX code should distinguish either a Z00.00 or Z01.419.
 

SharonCollachi

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The original question was can you bill both for non-medicare, and I was asking how were they not all together an annual physical/wellness visit/whatever your office calls it.
 

elenax

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Very interesting, thank you all for your feedback. I do agree with twalls. I think the difference is the diagnosis code. Any advise on how the above denial should be handled?
 

SrideviS

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Yes, it is very confusing but they are not the same and below is why. We are getting denials and it is my impression that they just pay for one and not both in a year.

An annual physical typically involves an exam by a doctor along with bloodwork or other tests. The annual wellness visit generally doesn't include a physical exam, except to check routine measurements such as height, weight and blood pressure.

What is a wellness exam? An annual exam is a comprehensive preventative exam with your primary care provider for the sole purpose of preventative care. An annual exam does not include discussion of new problems or detailed review of chronic conditions. Annual exams may also be called routine check-ups, yearly exams, an annual pap, or preventive visit.

Thank you,
Hi all,

Need clarification on selection code for Routine physical exam and AWV.
Encounter and summary states routine physical exam in CC and in HPI, PE is covered with 14 system whereas A/P header contain few disease condition and screening for depression. What needs to be coded here and how to differentiate the service between these.
 

SrideviS

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What is the CPT code for these screening both in medicare and commercial insurance?
Fall Risk Assessment, NIDA test, PHQ-2 with 0 score(without time), opioid risk- 10 score, morse fall scale- 15 score, katz ADL- 6 score
 
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