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Wiki AWV and an E/M

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kjfzak@yahoo.com

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What is your interpretation of the allowed billing of an AWV with an E/M? My understanding is that if a provider is clearly documenting chronic illness management and has in his assessment and plan that patient is to continue current management this is allowed. I'm currently auditing NGS claims. Anyone have specific auditing experience with them?
 
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It depends on what conditions you are associating with the E/M visit. A separate E/M visit cannot be billed if the record only reflects the status of each condition and/or if the status is copied over from the previous note. However, if the chronic condition(s) are not stable and/or if an acute condition is being addressed and worked up then an E/M can be billed in addition to the AWV. Here is some information from NGS regarding this topic. Please feel free to reach out to me directly if you have any further questions.

https://www.ngsmedicare.com/ngs/por...usetts&jurisdiction=Jurisdiction+K&LOB=Part+B

Sincerely,

Jennifer Kastner, CPC, CPMA, CEMC
Senior Consultant
jkastner@pyapc.com
 
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