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Medicare Annual Wellness Visits

  1. #1
    Question Medicare Annual Wellness Visits
    Medical Coding Books
    Could anyone explain the new Medicare AWV? What type of provider does the "Initial Preventive Physical Exam"? How do you verify that the patient has had the IPPE?

  2. #2
    The IPPE code is G0402 and is a once-in-a-lifetime benefit payable only during the first 12 months of the Medicare Part B effective date. Any provider can do this & bill it, as long as documentation guidelines are met. Verfication can be done with your patient &/or the previous medical providers. I don't believe Medicare will tell you if another provider has billed this out.

    The Initial AWV, G0438, is also a once-in-a-lifetime benefit, payable only after the patient has had Part B for more than a year. Again, verification can be done with your patient &/or the previous medical providers. If the patient truly has not had a physical within the past year, and you get a denial on the G0438, then it may be that you need to resubmit your claim with a G0439 code instead. The G0439 code covers all subsequent physicals and is an annual benefit.

    Does that help? I don't have any personal experience billing out the G0438 & G0439 codes yet (duh)--the above information is what I've gathered from a Coding Alert article.

    Becky, CPC

  3. Default Annual Medicare Well-Woman Exams
    ACOG states that the AWV is generally not appropriate for OB/GYN because it includes a component of preventive plan that is usually the responsibility of the patient's PCP and not handled by the OB/GYN. Also is does not include the Pap, breast exam screenings. They provide an excellent sample letter of explanation to the patient. At this time it appears that the most appropriate billing for a Medicare patient is still the preventive exam codes with "carve outs" for the Medicare covered preventive exam components of Pap smear and breast exam OR the carve out of an E&M code for a specific medical diagnosis addressed during the annual well-woman exam.

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