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The Field Guide to Physician Coding 2nd Edition


Forum Discussion Areas > Ask Us a Question > established annual exam under Medicare
  established annual exam under Medicare
cformby
established annual exam under Medicare
Posted:
Sep 20 2012, 5:42 PM
what CPT® codes should my doc really be using for an annual exam on a Medicare pt we have conflicting and arent for sure HELP

 
nmaguire
re: established annual exam under Medicare
Posted:
Sep 20 2012, 6:06 PM
There are two types of AWVs - the first annual wellness visit (G0438) and subsequent annual wellness visits (G0439). G0438 may not be billed if the patient received an IPPE.

The initial Annual Wellness Visit (G0438) includes:

routine measurements such as height, weight, blood pressure, body-mass index (or waist circumference, if appropriate); review of medical and family history; establishing a list of current providers, suppliers, and medications (including supplements); a personal risk assessment (including any mental health conditions); a review of functional ability and level of safety; detection of any cognitive impairment; screening for depression; establishing a schedule for Medicare’s screening and preventive services your client qualifies for over the next 5 to 10 years; and, any other advice or referral services that may help intervene and treat potential health risks. The subsequent Annual Wellness Visits (G0439) include:

measurement of weight, blood pressure, and other measurements deemed appropriate (note: height and body-mass index not necessary, unless your client has had significant weight change); an update to medical and family history; an update to the list of providers, suppliers, and medications (including supplements); a review of the initial personal risk assessment; detection of any cognitive impairment; an updated screening schedule; and, a review and update to list of referral services to help intervene and treat potential health risks.

 
Codapedia Editor
re: established annual exam under Medicare
Posted:
Sep 21 2012, 4:14 PM
But don't use the wellness visit codes unless you meet the criteria for them. If you are doing a typical preventive medicine service it is still non-covered and must be billed to the patient. Obtain an ABN.

 

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