Ah, I can always count on you ....! LOL
Originally Posted by mitchellde
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, CPC, PCS, COC
Dover, NH 03820
If you can dream it, you can do it. Walt Disney