Wiki Credentials of who can perform Wellness

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wynonna

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Please help: desperate to find out answer for an MD/billing meeting.
Can an LPN (licensed practical nurse) or RN (registered nurse) perform any part of Wellness?
For example: For G0402--Intro to Medicare?, G0438--Initial Wellness?, or G0439--Subsequent wellness?
If yes, which areas can he/she participate in? (gathering info re: screening tests, history, risk factors, chief complaint, if any)
Can a RN or LPN perform any part of the physical exam?
Thank you!!
 
Here is an official FAQ from CMS:

"Who can perform an Annual Wellness Visit?
Medicare Part B covers the Annual Wellness Visit (AWV) if it is furnished by a:
• Physician (doctor of medicine or osteopathic medicine)
• Physician assistant
• Nurse practitioner
• Clinical nurse specialist
• Medical professional (including a health educator, a registered dietitian, nutrition professional, or other licensed practitioner) or a team of such medical professionals working under the direct supervision of a physician (doctor of medicine or osteopathy). As discussed in the preamble of the calendar year 2011 Physician Fee Schedule rule, CMS is not assigning particular tasks or restrictions for specific members of the team. We believe it is better for the supervising physician to assign specific tasks to qualified team members (as long as they are licensed in the State and working within their state scope of practice). This approach gives the physician and the team the flexibility needed to address the beneficiary’s particular needs on a particular day. It also empowers the physician to determine whether specific medical professionals who will be working on his or her wellness team are needed on a particular day. The physician is able to determine the coordination of various team members during the AWV."

Additional general readings on IPPE
Additional general readings on AWV
 
Clinical Nurse Specialist

Thank you--very helpful!
For Clinical Nurse specialist, anyone familiar with which credentials/licensing this means? For example, LPN (licensed practical nurse) or RN (Registered nurse) or can both perform Wellness?
thank you
 
For definitions on what a Clinical Nurse Specialist (CNS), I went with their association.

CMS also designates a CNS as:

1. Be a registered nurse who is currently licensed to practice in the State where he or she practices and be authorized to furnish the services of a clinical nurse specialist in accordance with State law;
2. Have a master’s degree in a defined clinical area of nursing from an accredited educational institution; and
3. Be certified as a clinical nurse specialist by a recognized national certifying body that has established standards for CNSs.

CMS Medicare Benefit Manual 15.210

So in other words, a CNS would be at least an RN who has had advanced training and education above the RN level.

Whether a LPN or RN can perform any parts of the AWV/IPPE, CMS explains this is up to the individual provider. Also, remember that the IPPE/AWV is not a Complete Physical Exam, but merely hits on some of CMS desired metrics.
 
Clinical Nurse Specialist

Again, very helpful, and thank you!
"CMS explains this is up to the individual provider". so is there a reference in AMA version of CPT or section in Medicare/CMS/NGS website where I can find these very helpful details?
thank you again
 
Signature when RN completes Annual Wellness Visit?

Is just the RN signature sufficient on the Annual Wellness Visit? Or must the supervising provider countersign?
 
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