Question AWV split with timed E/M?

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Waterloo, IA
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Hello. I have a provider who did an Medicare annual wellness visit plus split out an E/M stating that 70 minutes were spent beyond the time spent on AWV. I can't find anything regarding billing a timed E/M with AWV. I believe in the past if they added the timed statement, we could only bill the E/M? Welcoming any input. Thanks.
 

thranowski

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Orlando, FL
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Hello. I have a provider who did an Medicare annual wellness visit plus split out an E/M stating that 70 minutes were spent beyond the time spent on AWV. I can't find anything regarding billing a timed E/M with AWV. I believe in the past if they added the timed statement, we could only bill the E/M? Welcoming any input. Thanks.

We bill well visits and problem visits separately just as we always have. If the physician puts the time spent on the problems, we bill by time, or if they are clear in their MDM then we bill by that. Generally whichever E&M is higher value.

In the case above, I would bill 99395-25, 99215-25, 99417.

Edit: sorry, I missed over the Medicare part. disregard my CPT codes. I would still bill both together.
 
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CBLENNIE

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The OP indicated the provider performed a Medicare AWV and Medicare will not cover 99395-25, an AWV should be billed with either of the following codes:
  • G0438-Annual Wellness Visit; includes personalized prevention plan of service (PPS), initial visit [Initial annual wellness visit (AWV) includes taking the patient's history; compiling a list of the patient's current providers; taking the patient's vital signs, including height and weight; reviewing the patient's risk factor for depression; identifying any cognitive impairment; reviewing the patient's functional ability and level of safety (based on observation or screening questions); setting up a written patient screening schedule; compiling a list of risk factors, and furnishing personalized health services and referrals, as necessary.]
  • G0439-Annual Wellness Visit; includes personalized prevention plan of service (PPS), subsequent visit [Subsequent annual wellness visits (AWV) include updating the patient's medical and family history, updating the current provider list, obtaining the patient's vital signs and weight, identifying cognitive impairment, updating the screening schedule, updating the risk factors list, and providing personalized health advice to the patient.]
 

thranowski

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Orlando, FL
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The OP indicated the provider performed a Medicare AWV and Medicare will not cover 99395-25, an AWV should be billed with either of the following codes:
  • G0438-Annual Wellness Visit; includes personalized prevention plan of service (PPS), initial visit [Initial annual wellness visit (AWV) includes taking the patient's history; compiling a list of the patient's current providers; taking the patient's vital signs, including height and weight; reviewing the patient's risk factor for depression; identifying any cognitive impairment; reviewing the patient's functional ability and level of safety (based on observation or screening questions); setting up a written patient screening schedule; compiling a list of risk factors, and furnishing personalized health services and referrals, as necessary.]
  • G0439-Annual Wellness Visit; includes personalized prevention plan of service (PPS), subsequent visit [Subsequent annual wellness visits (AWV) include updating the patient's medical and family history, updating the current provider list, obtaining the patient's vital signs and weight, identifying cognitive impairment, updating the screening schedule, updating the risk factors list, and providing personalized health advice to the patient.]

Sorry, my fault. I totally skipped over the Medicare part. But otherwise I would still bill both together.
 
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