Wiki AWV, Preventive visit, office visit

[akmorgan]

Looking for information regarding reporting an AWV, preventive and office visit on the same DOS. I have started seeing this some with providers and wondering if these three codes can be reported on the same DOS. I have not been able to find much information about it and would appreciate any advice I could get on this and if there any resources or guidelines.

Thank you.

 

[Pathos]

I suppose it is plausible, but providers should be careful not to unbundle codes. Some preventive codes are considered part of the AWV, and there may some overlap between AWV and E/M visits.

If medical necessity allows an AWV and E/M visit on the same day, CMS directly explains how this is done on page 9:
"When you furnish a significant, separately identifiable, medically necessary Evaluation and Management (E/M) service along with the AWV, Medicare may pay for the additional service. Report the additional Current Procedural Terminology (CPT) code with modifier -25.
That portion of the visit must be medically necessary to treat the beneficiary’s illness or injury, or to improve the functioning of a malformed
body member."

Same goes with general preventive visits and regular E/M visits. There has to be enough medical necessity to allow an E/M, or vice-versa. Some payors will flat out deny the other service when billing preventive and E/M on the same day, some will pay at a reduced rate. To avoid confusion, our Clinic have agreed to focus on what was spent most time on. If 50% or more was spent on the preventive portion, then bill that; and vice-versa for the E/M portion.

Here is CMS Preventive Interactive Tool on their different services offered.

Hope that helps!