Medicare annual wellness, workman's comp


Jackson, TN
Best answers
:confused: I have a question;

A provider sees a Medicare patient for a workman's comp followup visit (neck injury). The patient also has multiple medical problems (hypertension, hyperlipidema, diabetes) and these problems are addressed, rx written, labs ordered and done. Finally, the Medicare wellness visit it completed. All 3 visits are documented appropriately and could "stand alone". Is it correct to bill workman;s comp, the Medicare wellness visit, and the level 4 office visit with a modifer? SUch as this:
Bill W/c
99214- 723.1, e849.3
Bill medicare
99214, 25, 401.9,250.00,272.4
g0438- v70.0

Pam Brooks

True Blue
Local Chapter Officer
NAB Member
South Berwick, ME
Best answers
This can be done, according to our contractor NHIC, but make sure your documentation is spot on.

The Worker's comp visit must be documented on an entirely separate page/template, so that only those notes are submitted to the WC carrier. In fact, we open an entirely different EMR template when doing a WC visit at the same time as a visit involving the health insurance. And of course, you can't double dip by using the same HPI or ROS information for both E&M charges.

Make sure, as well, that the E&M portion of the note is separately documented from the AWV, and that there's been no double-dipping of elements that are specificallly required for the AWV, such as PFSH, or psychiatric exam components. If you use PFSH to meet a detailed HPI, then you won't meet your AWV criteria. If you're good, then put the -25 on the office visit.

Your other issue with this is that patients think of the AWV as a 'free' exam. If you bill that office visit with the AWV, it will bump up against deductible and co-insurance. Make sure your patient understands that, because we've had to field calls from patients who are very unhappy that their 'free' visit wasn't free after all.

Please let us know if you had any issues with payment, I'm curious as to what other contractors are doing with this scenario. Thanks!