Wiki Annual Wellness Visit - the only coder


Twin Falls, ID
Best answers
Am I the only coder out there who still gets opposition from nursing/provider teams who decline Medicare patients there annual wellness visits and bill out preventative codes? Which now are the patients full responsibilty.
I hear every excuse in the book when it comes to why they won't offer the service.
What is your model for the AWV? Is it given by a provider or nurse, NPP, or PA?
If a nurse/provider team offer the AWV model does your nursing staff do most of the prep work before the patient arrives.
This post will probably be like the start of WWIII, keep it clean and nice please.
Annual wellness

Hi Jeff,

I am a coder at a resident clinic, and this has been difficult for us as well. Most of the residents opt not to do the annual wellness, unless the patient specifically asks for it.

As you know Medicare patients usually have many chronic conditions, and that is what is addressed when they come in for their "yearly check".

I have not been able to get one of these visits that meet the guidelines to bill out. I am hoping Medicare will come up with some education tools such as examples of what documnetation is required.

Good luck,

LIsa Gasho, CPC Via Christi Health Systems
AWV is not a physical

Just wanted to make sure that you realize the AWV is charged in addition to the 9939x not in place of it if a "yearly checkup" is done.

It is possible to just do the AWV but there is not a physical exam beyond what can be done by a nurse. The AWV does not require a physician to see the patient at all.

WPS has a really nice Q&A page with links to CMS documents.

There are also forms already created and available for use published on the internet. I found a few when I googled a few days ago. The link below is to a site that I thought had some nice ones.

Hope this is helpful,


We do bill these out with success when they are offered. I code for family practice and internal medicine, IM is where most of the problems occur with non-conformity and of course IM has the highest populaton of Medicare patients.
We have had our coding research team put together, with WPS help I'm sure, a 3 page form that needs to be filled out by patient, and provider. Our annuall wellness visit (AWV) is performed by a provider.
We are educating our providers, per WPS, that they can split bill the encounter when dealing with other chronic issues ontop of the AWV. We are not billing out a preventative 9939_ because the patient would be fully responsible for these codes.
We currently have providers performing the AWV visit. This may change, by talks of our, AWV team consisting of providers and research staff, but as many of you can guess they have been going round and round for months with no solutions foreseeable.
Our physicians and midlevels are billing this service, and we devised a custom EHR template in our software to capture the elements that CMS requires. Most of the work is done by our providers, but clinical staff does do some of the pre-work such as vitals, verifying PFSH and list of providers that the patient is seeing. Payment and work RVUs are significant, so I'd encourage your providers to think about this, particularly if they have a large Medicare population. We've chosen to not bill any other visits at the same time, because patients think of this as their 'free' wellness visit, and adding on an office visit will result in deductible/copayment issues. We have started marketing this service to our Medicare population, and have a team of nurse practitioners who are going to offer this service regularly. We see it as a great opportunity.
I too have a large population of patients that are Medicare patient. The AWE is done by the physician and if there is another issue that needs to be addressed I also bill out an additional E/M visit with the 25 modifier. I have not had any issues billing this way.