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

  1. #31

    Smile

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    Quote Originally Posted by MMAYCOCK View Post
    No, G0438 is not dependent on the Welcome to Medicare IPPE visit. That is not an annual benefit. The
    G0438 is used for the First Annual Wellness Visit- Other than the mandatory time lapse, it doesn't matter if the patient did or did not have the IPPE. The G0438 is used the first time the patient takes advantage of the annual wellness visit. Every year after that, the G0438 will be used to indicate that it is a subsequent wellness visit and that the first annual wellness visit has been performed - by your office or another. That is not a factor.
    The subsequent visits should be billed with the procedure code G0439.

  2. #32
    Join Date
    Apr 2007
    Posts
    17

    Question AWV questions

    my docs have questions about this, which i have been unable to get from the website and I have left messages for Medicare to call me back. when they say one AWV a year is it 365 days (exactly) or if they have a AWV in January can they have a subsequent on the next January? My doc wants this in writing from them....Where can I find this?
    On the MLN pertaining to the AWV it states effective January 1 2011, implementation date of April...what does the implementation date stand for. Any Help is appreciated.

  3. #33

    Default AWV timeframe between visits

    Question:
    The guidelines on the AWV show that Medicare will allow the service once per year. Is this period based on a 365-day year or 12 months?
    Answer:
    Medicare would look to verify that at least 11 full months have passed since the last AWV.


    Here is the link to the full Q&A page - this is from WPS

    http://www.wpsmedicare.com/j5macpart.../awv-faq.shtml

  4. #34
    Join Date
    Apr 2007
    Location
    Coastal Coders
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    417

    Default

    Usually "Once a year" is pretty clear. Does your Dr not understand the concept of time?
    I mean come on really? Stand up and tell him. One yr equals 365 days Doc. Schedule the pt back on the 366th day. Issue closed.
    I would approach a situation like this as follows:
    It's your practice Dr., the guidelines for the AWV clearly state one per yr.
    I am advising that you do not schedule any more than that.

  5. #35
    Join Date
    Apr 2007
    Location
    Dover Seacoast New Hampshire
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    1,911

    Default

    Quote Originally Posted by Oceanlivin View Post
    Usually "Once a year" is pretty clear. Does your Dr not understand the concept of time?
    I mean come on really? Stand up and tell him. One yr equals 365 days Doc. Schedule the pt back on the 366th day. Issue closed.
    I would approach a situation like this as follows:
    It's your practice Dr., the guidelines for the AWV clearly state one per yr.
    I am advising that you do not schedule any more than that.
    LOL....I needed a laugh this morning......This is why we'll always be employed!

    I was once told by a physician colleague (who is also a certified coder) that his CPC exam was far more challenging than his medical boards.

    Enough said. Keep up the good work everyone!
    Pam Brooks, MHA, CPC, PCS, COC
    Coding Manager
    Wentworth-Douglass Hospital
    Dover, NH 03820

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

  6. #36
    Join Date
    Apr 2007
    Posts
    11

    Default

    Hi,

    Could you please send me your brochure and check list? My email address is henrylg@umdnj.edu.

    Thank you,
    Linda

  7. #37

    Default

    Decision Health has an encounter form on their website that you can print out and use for the new wellness visit, G0438 & G0439

  8. #38

    Default

    I was able to locate some very comprehensive paperwork on the AAFP website if your physicians have membership/access which states at the bottom may be photocopied or adapted for use by physicians in their own practices. If you don't have access try http://www.aafp.org/fpm/20110100/p22.html to possibly get straight to the forms.

  9. #39
    Join Date
    Apr 2007
    Location
    Sierra Vista AZ Hummingbirds
    Posts
    14

    Default G0438 and G0101

    I billed these without any modifiers and the G0438 was denied. Would I use -25 or -59? Is G0438 considered an E&M or procedure? If a modifier is needed, then why isn't it listed in the NCCI edits??? Thanks

  10. #40
    Join Date
    Apr 2007
    Location
    East Valley Kachina Coders
    Posts
    7

    Default

    Pam,
    Could you share your FAQs you prepared?

    Thank you,
    Janet
    jclark@adaptivebilling.com

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