Hello All:
I believe I know the answer to this question but you know how brain farcts are--- they come and they go....
Here is my scenario....
72 yr old patient comes in for AWV, she's of course not new to Medicare within the past 12 months, has had it for quite some time now, the provider has stated he is billing the subsequent AWV. This is a patient he has been following for years and years and years... I asked why he's not billing the Initial AWV, he says because " I would have had to bill that last year, since this was a new service for 2011, and since this is 2012 it's the subsequent".
I did read the IOM on CMS's website and I believe he should be billing the Initial AWV G0438 because the patient hasn't had an IPPE ever, and she has not had her Initial AWV in 2011 when these codes became effective.
I then proceeded to show him what elements/components are included in the subsequent AWV ( which build off of the initial AWV) basically the updaing the list of curent medical providers/suppliers, updating the patient's list of risk factors updating the patients medical history/family history as well, updating the patients written screening schedule as developed in the first AWV providing PPPS.
When I look at his office note, he actually is doing the Initial AWV.
My question is this....
If a patient has never had the initial AWV in 2011 but comes in in 2012 wouldn't that be the time the provider is doing the INITIAL AWV and not a subsquent?
Am I confusing anyone else yet?
I believe I know the answer to this question but you know how brain farcts are--- they come and they go....
Here is my scenario....
72 yr old patient comes in for AWV, she's of course not new to Medicare within the past 12 months, has had it for quite some time now, the provider has stated he is billing the subsequent AWV. This is a patient he has been following for years and years and years... I asked why he's not billing the Initial AWV, he says because " I would have had to bill that last year, since this was a new service for 2011, and since this is 2012 it's the subsequent".
I did read the IOM on CMS's website and I believe he should be billing the Initial AWV G0438 because the patient hasn't had an IPPE ever, and she has not had her Initial AWV in 2011 when these codes became effective.
I then proceeded to show him what elements/components are included in the subsequent AWV ( which build off of the initial AWV) basically the updaing the list of curent medical providers/suppliers, updating the patient's list of risk factors updating the patients medical history/family history as well, updating the patients written screening schedule as developed in the first AWV providing PPPS.
When I look at his office note, he actually is doing the Initial AWV.
My question is this....
If a patient has never had the initial AWV in 2011 but comes in in 2012 wouldn't that be the time the provider is doing the INITIAL AWV and not a subsquent?
Am I confusing anyone else yet?
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