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Coders: Annual Wellness Visit--Read the Guidelines!!

  1. #21
    Location
    Evansville Indiana
    Posts
    451
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    Medical Coding Books
    They did not allow questions or feedback, but gave the e-mail for support to send questions.
    They pretty much just read the powerpoint that stated the guidelines.
    LeeAnn

  2. Default
    Quote Originally Posted by Lisa Curtis View Post
    You are absolutely correct Pam! These new "services" are not physicals in any way shape or form. The only "hands on" required are vitals.
    Thank you for sharing your knowledge. We so appreciate it! We feel unsure of what to do!

  3. Default
    CMS does refer to the AWV as a preventive exam. It's stated twice:

    Annual Wellness Visit (AWV)

    Effective January 1, 2011, Section 4103 of the Affordable Care Act (ACA), allows for a preventive physical examination, called the annual wellness visit (AWV), and includes personal prevention plan services (PPPS). The AWV is a new annual Medicare preventive physical examination, available for eligible beneficiaries, and identified by new HCPCS codes G0438 (Annual wellness visit, including PPPS, first visit) and G0439 (Annual wellness visit, including PPPS, subsequent visit).


    http://www.cms.gov/Transmittals/downloads/R2109CP.pdf

  4. #24
    Location
    Columbia, MO
    Posts
    12,531
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    I have gone over this with the fine toothed comb so to speak and sat with a physician while we went over the requirements and role played out the visit. There is no way to accomplish all of the requirments with merely vital signs. The provider must examine the patient to determine if there is evidence of any cognitive imparement, or to review for functional ability. While they have specifics that must be documented to meet the objectives, in order to document these things the provider needs to perform certain examinations. I am not totally comfortable with telling the provider that this is not a preventive examination, that it is vitals only. I think this is an incorrect message, and also we must remember that the patients were told by Medicare they would pay nothing for preventive services after january 1 2011. To use the AWV as a vital signs only and then reschedule the patient for the preventive encounter is going to be an issue, if you try to bill this as preventive, Medicare will deny it and the patient will be responsible which will cause great concern with these patients, or to reschedule a preventive and bill it as a level 4 or 5 encounter to have Medicare pay for it is potential for fraud. I agree with the above.. AWV is a preventive EXAMINATION encounter.

    Debra A. Mitchell, MSPH, CPC-H

  5. Default
    Great post Debra!

    Also...on another thread here (under general Medicare discussions I believe), there is a quote from a person at CMS who stated that the AWV is intended to be a continuation of the IPPE, even though the words "physical exam" were not specifically mentioned.

    Providers I've talked to agree with your thoughts that it would be difficult to do the AWV without examining the patient.

  6. Default G0438-G0439: Screening diagnostic tests
    What are the specific "screening labs” entitiled under these visits? It has not been clarified what those labs are (Welcome to medicare allowed for EKG and US abdomen if history of AAA). Has anyone found the reference regarding the above? Thanks in advance

  7. Default g0439
    what diagnosis code do you use with the G0438/G0439?

  8. #28
    Location
    Dover Seacoast New Hampshire
    Posts
    1,970
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    Quote Originally Posted by mitchellde View Post
    I have gone over this with the fine toothed comb so to speak and sat with a physician while we went over the requirements and role played out the visit. There is no way to accomplish all of the requirments with merely vital signs. The provider must examine the patient to determine if there is evidence of any cognitive imparement, or to review for functional ability. While they have specifics that must be documented to meet the objectives, in order to document these things the provider needs to perform certain examinations. I am not totally comfortable with telling the provider that this is not a preventive examination, that it is vitals only. I think this is an incorrect message, and also we must remember that the patients were told by Medicare they would pay nothing for preventive services after january 1 2011. To use the AWV as a vital signs only and then reschedule the patient for the preventive encounter is going to be an issue, if you try to bill this as preventive, Medicare will deny it and the patient will be responsible which will cause great concern with these patients, or to reschedule a preventive and bill it as a level 4 or 5 encounter to have Medicare pay for it is potential for fraud. I agree with the above.. AWV is a preventive EXAMINATION encounter.
    Ah, I can always count on you ....! LOL

    I agree, from a physician's perspective, they must examine the patient in order to determine cognitive defects, etc. but in considering the exam bullets in our audit tools, there are few instances where an exam of any detail would take place, for most patients.

    Overall, there is currently no requirement to do a head-to-toe exam, but in order to satisfy the psychiatric and functional elements of the AWV, the provider may have to do some of the examination elements, based on the patient's risk assesment. The only straightforward hands-on exam requirements (from an auditing perspective) specifically for the AWV are the vitals. For those providers using an EMR (such as mine), we have built specific templates to satisfy all of the AWV critiera; and in order to be able to provide this service in a timely manner, we excluded our standard Pe template, with the exception of the vitals. Of course, in order to meet the criteria as required, an examination in some form would take place, which we do allow them to document, but we did this within the confines of our customized template, and not as part of our standard Preventive physical. Thinking outside the box, as I have to do in the EMR world, we had to exclude our standard Pe template in order to have time and space to capture all of the required data.

    This is what I wanted to convey...that from a workflow perspective, it could get cumbersome to also document a head-to-toe, if it's not medically necessary. My doctors (Just our 45 primary care providers) fully understand the requirements of the AWV, and would not assume that they shouldn't 'examine' the patient in order to assess their risk.

    We also have to be very careful that we are not giving the wrong message to our patients, by giving them a blanket statement that preventive examinations are covered. In their minds, they might expect a hands-on, head-to-toe exam, and then will be annoyed if that's not what we provide. We did create a patient FAQ specifically to address this, but CMS has a very nice informative brochure that you certainly could all provide to your practices.

    For those of you that continue to have questions, you really should contact your local contractors. Some contractors seem to be handling this differently, and I can only speak to what I've learned from NHIC. There is much information on the CMS website, which we should all have in our "Favorites", and we have to make the best decisions for our providers regardless of what other coders (including myself) have done for their practices.
    Pam Brooks, MHA, COC, PCS, CPC, AAPC Fellow
    Coding Manager
    Wentworth-Douglass Hospital
    Dover, NH 03820

    If you can dream it, you can do it. Walt Disney

  9. Default
    May I also have a copy of your FAQ's?

    kate.plemel-dibble@vtmednet.org

  10. #30
    Default
    Quote Originally Posted by Jewel View Post
    What are the specific "screening labs” entitiled under these visits? It has not been clarified what those labs are (Welcome to medicare allowed for EKG and US abdomen if history of AAA). Has anyone found the reference regarding the above? Thanks in advance
    CMS has a quick reference on Medicare Preventive Services on their website...

    [url]http://www.cms.gov/MLNProducts/downloads/MPSQuickReferenceChart1.pdf
    Roxanne Thames CPC, CPC-I, CEMC
    rthamescpci@gmail.com


    "Remember the greatest gift is not found in the store but in the heart of true friends"

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