Wiki Need help with Primary Diagnosis for AWV G0402,G0438,G0439, Ran into a Conundrum.

[BUDO311]

Hey everyone, I had a rather interesting webinar that was provided by Humana regarding Medicare AWV's and in the webinar the presenter states that Z0000 and Z0001 should'nt be used, and threw me off, and I was wanting to know everyones thought's on this, is he right or wronge?

 

[mitchellde]

Interesting! I can’t think of any other diagnosis code that would fit for a general preventive exam. The idea being that a patient presenting for a wellness visit is at that moment in time essentially well with no complaints or overt signs of illness. Which is why the Z00 codes are a perfect fit for the medical necessity. Also I believe there is a Medicare transmittal that states the Z00 codes are the correct codes for these levels. I am curious as to what this trainer said was the appropriate code to use for a wellness visit.

 

[BUDO311]

Interesting! I can’t think of any other diagnosis code that would fit for a general preventive exam. The idea being that a patient presenting for a wellness visit is at that moment in time essentially well with no complaints or overt signs of illness. Which is why the Z00 codes are a perfect fit for the medical necessity. Also I believe there is a Medicare transmittal that states the Z00 codes are the correct codes for these levels. I am curious as to what this trainer said was the appropriate code to use for a wellness visit.

I was of the same idea and the Presenter works for Humana, but there guidelines are Medicare + whatever their own guidelines they add I guess. As to what code to report in place of that , He was talking about diagnosis related to the patients, I think he was referring to older medicare patients that are more then likely have some sort of chronic condition. I'd like to see that Transmittal your referring to, cause it confused everyone i work with. I'll continue to what i've been doing until its proven or not cause to say something like he did is a big change and is different from what i've read .

 

[mitchellde]

I agree.. I cannot see Medicare pay for a wellness visit without a wellness dx code first listed. If I run across that transmittal I will send it your way but it was ages ago when the. Does for wellness visit levels were introduced. I think your plan is best stay the course and do what you know is correct and can support with the chart note.

 

[twizzle]

Primary diagnosis for AWV's

Hey everyone, I had a rather interesting webinar that was provided by Humana regarding Medicare AWV's and in the webinar the presenter states that Z0000 and Z0001 should'nt be used, and threw me off, and I was wanting to know everyones thought's on this, is right or wronge?

Are you sure the presenter was saying don't use Z00.00 or Z00.01 on a separate E/M if the provider is also seeing the patient for review of their chronic problems and billing an established office visit in addition to the AWV? I see providers using Z00.00 on both codes which is clearly incorrect.

In my experience, webinars given by insurance companies sometimes convey incorrect or even ridiculous information.

 

[BUDO311]

Are you sure the presenter was saying don't use Z00.00 or Z00.01 on a separate E/M if the provider is also seeing the patient for review of their chronic problems and billing an established office visit in addition to the AWV? I see providers using Z00.00 on both codes which is clearly incorrect.

In my experience, webinars given by insurance companies sometimes convey incorrect or even ridiculous information.

It could be, and I was wanting to get some clarification on it as well, but sorta indirectly confirmed it by other people were asking things like " well if we cant put Z0000 what do we put instead" I think he might have been mixed up, and everyone was asking questions, I work with 5 other coders as well that saw the webinar as part of our continuing education, cause you know insurances are always changing so we try and keep up with that as well. The presenter indicated he'd send some supplemental info and if he does ill let you guys know. Thanks for replying with your thoughts, it reinforced what i already knew.

 

[tinasmith2020]

2023 Medicare Advantage preventive screening guidelines published by UHC specifically quotes "The annual wellness visit (AWV) is a yearly appointment with a Medicare beneficiary’s PCP to create or update a PPPS. This plan may help prevent illness based on current health and risk factors. An AWV is not a physical exam. Therefore, it is incorrect to report a Z00.0- code with an AWV."

I cannot find anything recommending another code besides Z00.00.

Please advise

 

[theisel@lakeviewclinic.com]

The Optum Regional Coding Educator from the Upper MidWest region indicated via our UHC rep that Z01.89 is the appropriate code to use for an AWV (encounter for other specified special examinations) along with the diagnoses the patient has for HCC coding. It is super common to use Z00.00 and so it's called out during coding reviews, but at this point, it does not stop a claim from being paid.