Medicare Wellness Visits--update

April 24th, 2013 - Codapedia Editor
Categories:   Medicare   Preventive Medicine Service   Primary Care|Family Care  
0 Votes - Sign in to vote or comment.

Physician practices know that fee-for-service Medicare doesn’t cover “annual” exams as defined by CPT® codes in the 99381—99397 series.   These preventive services are the typical annual exams that physicians use for well child visits and adult annual physical exams.  However, in 2011Medicare added the Annual Wellness Visits (initial and subsequent) to their list of covered services.  Medicare patients think of these as annual exams, and expect to receive the service.  Although practices resisted offering the service, and are not required by law to do so, many groups have changed their minds and are now offering them to their patients.  The patient receives the service and the practice adds a revenue source.

There are three steps to accomplish this: 1) Know when the patient is eligible for which covered services 2) Perform the requirements for the visit and 3) Schedule the patient for the correct type of visit in the appointment schedule.

Welcome to Medicare:  Medicare fee-for-service patients are eligible for the Welcome to Medicare visit(also known as the Initial Preventive Physical Exam, IPPE) during the first twelve months of enrollment.  For most patients, this means from ages 65-66. But, patients who are eligible for Medicare due to disability could be eligible at any age: the date of enrollment determines eligibility.  This is a once-in-a-lifetime benefit.  The patient may only receive one Welcome to Medicare visit in their life. (Code G0402)

Perform and document these components of the Welcome to Medicare visit:

·      Past medical, family and social history including medications and use of supplements

·      Review of patient's potential for depression using a screening tool recognized by national standards  

·      Review of patient's functional ability and level of safety using screening tool recognized by national standards 

·      Physical exam that includes height, weight, BP, calculation of BMI and screening for visual acuity and other exam components deemed appropriate

·      Performance and interpretation of an EKG became optional, starting Jan 1, 2009.  If performed, use G0403, not 93000 to report

·      Education, counseling and referral, as appropriate, based on the above

·      With the patient’s permission, discussion of end of life planning.

·      A written plan (which may be in the form of a checklist) given to the patient at the visit which refers them to Medicare covered preventive medicine services.

 

Initial Annual Wellness Visit (AWV):  A patient may receive their initial AWV if they have not received their Welcome to Medicare visit in the past 12 months, and have been on Medicare for over twelve months.  The initial visit is also a once-in-a-lifetime benefit.  Patients who have been on Medicare for longer than a year can have this service. (Code G0438)

Requirements of the Initial AWV:

  • Establish/update the patient's past medical, family and social history 
  • List patient's current medical providers, suppliers and all medications, including supplements
  • Starting January 1, 2012, give the patient a Health Risk Assessment to complete as part of the evaluation
  • Record height, weight, calculate BMI, BP and "other routine measurements"
  • Review potential for depression using an appropriate screening tool
  • Review individual's functional level of safety and ability to perform activities of daily living, fall risk and home safety
  • Detect cognitive impairment, via direct observation, interview, review of medical records or discussion with family
  • Establish a personalized, written preventive plan for the next 5-10 years with services recommended by the US Preventive Task Force
  • Furnish personalized health advice that includes listing of patient's conditions. risk factors, treatment recommendations, and methods to decrease risk factors such as smoking, obesity, etc.

 

Subsequent Annual Wellness Visit:  This is an annual benefit for Medicare patients, for which they are eligible one year after receiving the initial AWV.  (Code G0439)

Requirements:

·      Update all of the components of the AWV.

No specific diagnosis codes are required for any of the above visits.

Medicare covers other screening and preventive services with specific frequency and diagnosis code requirements.  CMS publishes a Preventive Services Guide, which practices can download.  This guide is due to be revised in early 2012, so be sure to check back to the CMS website to download an updated copy.  Scroll down the page to download “Medicare Preventive Services Quick Reference Chart” from https://www.cms.gov/PrevntionGenInfo/

Practices can find templates that meet the requirements for these visits at the websites of the American Academy of Family Physicians or the American College of Physicians.   Practices using an electronic health record can build the templates into their records.  For all of these services, staff members should complete the historical and screening data before the billing clinician enters the exam room.  The visits need to be scheduled as Welcome to Medicare or Annual Wellness visits, so that the medical assistant who is rooming the patient selects the correct form or template for the visit.  Many practices have the patient complete the history and screening sections before the visit.  A clinician may bill a problem oriented visit on the same day as one of these wellness visits, but cannot use any part of the wellness visit documentation to select the level of service for the problem oriented visit.  Other covered preventive services (such as the clinical pelvic and breast exam) may be performed and billed on the same day as a wellness visit. 

Although many groups were reluctant to offer these services initially, some providers are now actively recommending them to their patients. At the end of a problem-oriented visit, the provider asks the patient to schedule their wellness visit.  This ensures that the visit type will be correct in the schedule, the staff will open the correct template/use the correct forms and the provider can perform all of the required elements at the scheduled visit.

###

Questions, comments?

If you have questions or comments about this article please contact us.  Comments that provide additional related information may be added here by our Editors.


Latest articles:  (any category)

​​Polysomnography Services Under OIG Scrutiny
September 2nd, 2021 - Raquel Shumway
The OIG conducted a study dated June 2019 wherein they indicated that there were approximately $269 million in overpayments for polysomnography services for the period of 2014 through 2015. According to the OIG “These errors occurred because the CMS oversight of polysomnography services was insufficient to ensure that providers complied with Medicare requirements and to prevent payment of claims that didn’t meet those requirements.” So what are those requirements?
Medicare Advantage - The Fastest Growing Government-Funded Program Undergoing Multiple Fraud Investigations
August 16th, 2021 - Aimee Wilcox, CPMA, CCS-P, CST, MA, MT, Director of Content
Medicare Advantage is the fastest growing form of government-funded healthcare and the rate of fraud within this segment has come under increased scrutiny. Funding is determined by the health status of each beneficiary; therefore, accurate coding based on detailed documentation makes the medical record vital to the process because some ...
Billing Dental Implants under Medical Coverage
August 12th, 2021 - Christine Woolstenhulme, QCC, QMCS, CPC, CMRS
Implants can be costly to the patient and the provider, and it is crucial to understand how to bill a patient’s medical insurance to ensure there is adequate coverage for the best treatment. Implants are commonly billed in a dental office under a patient’s medical benefits.    Implants could be considered ...
New Codes for COVID Booster Vaccine & Monoclonal Antibody Products
August 10th, 2021 - Wyn Staheli, Director of Research
New codes have been announced for the COVID-19 booster vaccine, Novavax vaccine, and monoclonal antibody treatment.
Medicare's ABN Booklet Revised
July 29th, 2021 - Wyn Staheli, Director of Research
The “Medicare Advance Written Notices of Non-coverage” booklet, published by CMS’s Medicare Learning Network, was updated. This article discusses the changes to this booklet regarding the use of the ABN.
Chronic Pain Coding Today & in the Future
July 19th, 2021 - Wyn Staheli, Director of Research
Properly documenting and coding chronic pain can be challenging. As is commonly the case with many conditions, over the years, there has been a shift in the identification of different types of pain, including chronic pain. Understanding where we are now and where we are going will help your organization prepare for the future by changing documentation patterns now.
How Does Global and Professional Direct Contracting (GPDC) Affect Risk Adjustment?
July 15th, 2021 - Aimee Wilcox, CPMA, CCS-P, CST, MA, MT, Director of Content
CMS recently announced the 53 Direct Contracting Entities (DCEs) that will be participating in the April 1, 2021 through December 31, 2021 Global and Professional Direct Contracting (GPDC) Model. Among those participating is Clover Health Partners, who runs an in-home primary care program that has the potential to help Medicare ...



Home About Contact Terms Privacy

innoviHealth® - 62 E 300 North, Spanish Fork, UT 84660 - Phone 801-770-4203 (9-5 Mountain)

Copyright © 2000-2021 innoviHealth Systems®, Inc. - CPT® copyright American Medical Association