Wiki Wellness Exam Vs. Yearly Physicals

[encomma-watson]

Happy Holidays to you all:

My Front desk staff, who makes appointments for patient cannot seem to get this right. So I need some insight - Wellness exams - my billing manager told me to add to the schedule New Wellness Exam: Biometrics and Establish Wellness Exam: Biometrics. This need no fasting requirements. On the other hand Yearly Physicals requires the patient not to eat or drink anything after midnight. When we go to code these two different exams, for the New Wellness Exam: Biometrics and Establish Wellness Exam: Biometrics my billing manager states to bill a 99202 and 99212 accordingly. Is the correct way of billing. The Yearly Physicals are according to age and New vs Establish. Can someone help me on this.

 

[Pam Warren]

You would not bill an office visit (new or established) if you are performing any sort of preventive or screening care, such as biometrics.
To bill an office visit for preventive care would likely cause a denial, and certainly (per CPT) those office visits are specifically for patients presenting with complaints or conditions. If you look at the key components: they all require History, exam and decision making that are dependent on details of a problem. If the practice wants to establish wellness through some new program that is primarily preventive, then they should bill the Preventive Medicine codes, not office visit codes.

The guidelines for the typical preventive care are outlined in CPT (99391-99396), and that would include any non-Medicare screening, risk reduction, disease prevention and age-appropriate preventive counseling. Preventive counseling (alone) is reported by 99401-99404. Remember, that payers may cover only one preventive visit per year so if you break these out into different kinds of preventive visits, you may have unhappy patients. It's best to do one comprehensive wellness visit for your non-Medicare patients.

For Medicare patients, there's the IPPE (Welcome to Medicare risk assessment), and the AWV (Annual Wellness Visit) which is done each year. These are not the typical head/toe physicial, but CMS has done a good job outlining what is expected to be reviewed from a preventive and risk reduction perspective. I find that in addition to the documentation expectations for IPPE and AWV, our providers also use this time to do a fairly comprehensive exam; that's their choice.

Hope this helps.