AWV initial or subsequent

rthames052006

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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?
 
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ollielooya

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Hi, Roxanne, I've been doing some research on a related topic as well and my thoughts are that if this doctor bills the G0439 instead of the G0438, wouldn't it a denial code be generated ? I found a comment relating to a similar issue (where the patient thinks they had an initial AWV but wasn't sure) and SHOULD THE SUBSEQUENT BE BILLED? Scroll a little more than halfway down...Don't know if this will help but since I'm researching similiar materal thought I'd share.

http://www.wpsmedicare.com/part_b/resources/provider_types/awv-faq.shtml

Suzanne E. Byrum CPC
 

Herbie Lorona

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From what I understand if the patient has never received there intial AWV then you would bill that. If you bill an Initial and they already have received it they will deny the code because it is only covered once. Also if you bill the Inital AWV within the first 12 months from when they start they will deny the code. I have billed out Initial AWV codes this year on patients who have been our patients for years now and we have not had any problems getting them paid.
 

rthames052006

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From what I understand if the patient has never received there intial AWV then you would bill that. If you bill an Initial and they already have received it they will deny the code because it is only covered once. Also if you bill the Inital AWV within the first 12 months from when they start they will deny the code. I have billed out Initial AWV codes this year on patients who have been our patients for years now and we have not had any problems getting them paid.
Thank you! Your last sentence is what I was looking for :)!

Sometimes when I tend to over think things I get myself confused! Imagine that!
 

CBaer

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AWV initial vs Subs

I agree with Herbie Lorona, as for the AWV, the Initial can be performed anytime after the first 12 months a patient is on Medicare. 12 months after the Initial AWV the patient is eligible for the Subs AWV (it may be an elapse time of 11 months that will need to be verified).

During the first 12 months and IPPE should be performed.

You all have a great day.
Cheryl
 
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