Alcohol Misuse Screening & Counseling
These are two services that are provided regularly, with the misuse screening almost always performed and the counseling performed when potential misuse is identified. All patients are eligible for alcohol screening patients who are eligible for counseling must screen positive and be competent and alert at the time you deliver the counseling. Code alcohol misuse screening and counseling with the following:
Reporting A Medically Necessary Evaluation And Management Code With An Annual Wellness Visit
- G0402 for the first 12 months of eligibility
- G0438 for the first visit after the 12 months of eligibility
- G0439 for all subsequent visits after the first two
- When using the AWV codes, report diagnosis code V70.0 for an adult exam since this is the reason for the visit.
- Next, list all chronic conditions secondary, tertiary, etc. Note: If you have several chronic conditions to add and your Practice Management system has software limitations, use code 99080 to add additional diagnoses. Blue Cross and Blue Shield of Alabama accepts up to 12 diagnoses on a claim.
- When using an E& M code for a sick visit with the AWV, use the diagnosis code that represents the problem or abnormality to match the additional documentation in the medical record. Remember to add modifier -25 to the E& M code.
- Reminder: Make sure to use the appropriate HCPCS “G” code when submitting your claim for the AWV. This will ensure that your practice receives credit for each patient who receives this service.
- When submitting the HCPCS “G” code for the AWV, be sure to submit it along with a dollar amount so the line item will not reject and you can receive reimbursement and credit for that service.
Medicares Annual Wellness Visit
The Medicare Annual Wellness Visit is a yearly appointment with a health professional to identify health risks and help reduce them and to create or update a personalized prevention plan. During a Medicare AWV, health professionals should also review any current opioid prescriptions, detect any cognitive impairment, and establish or update medical and family history.
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Three Unique Codes: G0402 G0438 And G0439
Medicare preventive wellness visits fall into three categories the Welcome to Medicare Visit, also known as the Initial Preventive Physical Exam , the initial Annual Wellness Visit, and subsequent Annual Wellness Visits. Each has its own Current Procedural Terminology code that must be used in the right circumstances and proper order.
During the first twelve months a patient is enrolled in Medicare, they are eligible for the Welcome to Medicare Visit. This is a one-time visit that includes vital measurements, a vision screening, depression screening, and other assessments that are meant to gauge the health and safety of an individual patient. This visit must be coded using CPT G0402. Once a patient has been enrolled for more than twelve months, the G0402 code will be rejected regardless of whether the IPPE visit previously took place or not.
After a patient has been enrolled in Medicare for twelve months, they become eligible for an Annual Wellness Visit. If they completed an IPPE, the patient is eligible for the initial AWV on the first day of the same calendar month the following year. An AWV is similar to the IPPE but includes slightly different required and accepted screenings. This initial AWV must be coded using G0438.
What Cpt Code Is 99395
99395- Periodic comprehensive preventive medicine reevaluation and management of an individual including an age and gender appropriate history, examination, counseling/anticipatory guidance/risk factor reduction interventions, and the ordering of laboratory/diagnostic procedures, established patient 18-39 years.
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What Is The Medicare Annual Wellness Visit
The Annual Wellness Visit allows practices to gain information about the patient, including medical and family history, health risks, and specific vitals. Not to be confused with a complete physical examination, the purpose of the AWV is to review the patients wellness and develop a personalized prevention plan. The services provided during the AWV are different from a typical preventive care visit and expand to include emotional and psychological well-being, in addition to the patients physical well-being. The AWV provides an opportunity for physicians to improve the quality of care, assist in patient engagement, and optimize payment opportunities.
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Billing And Coding The Visit
Two G-codes are used to identify the AWV for purposes of Medicare payment: G0438 AWV, including Personalized Prevention Plan Service, first visit, and G0439 AWV, including the Personalized Prevention Plan Service, subsequent visit. These services are typically provided in a physician’s office. However, the services can be provided in a facility and indicated by âlocation of serviceâ on the Form 837.
Any appropriate diagnosis code is acceptable for billing an AWV. Examples of acceptable diagnosis codes that could be included on the claim are V70.0, V70.8, or V70.9, as well as any other valid, appropriate diagnosis codes.
A first AWV can be billed only once in a lifetime using code G0438. The subsequent AWV, G0439, can be billed annually provided that 11 full months have passed since the previous AWV.
Medicare providers may perform a medically necessary diagnostic electrocardiogram on the same day as an AWV . Because some past claims for diagnostic EKGs performed on the same day as the AWV have been denied, CMS has made claims processing changes to allow payment for a diagnostic, medically necessary EKG performed on the same day as an AWV.
For more information and resources to use when providing the AWV, go online to ACP’s Running a Practice resource.
Brian Outland is an associate for regulatory affairs in ACP’s Department of Health Policy and Regulatory Affairs.
Interprofessional Approaches To The Awv
Traditional primary care clinicians, such as physicians and nurse practitioners, are not the only providers who can complete the AWV. Per the Centers for Medicare and Medicaid Services regulations, the Medicare Annual Wellness Visit may also be completed by registered dieticians, health educators, or other licensed practitioners, or by a team of medical professionals who are under the supervision of a physician. In light of these regulations, there are a number of published approaches to completing AWVs, including pharmacist-led, nurse-led, shared appointment, and inter-professional team visits.
For example, in the pharmacist-led model, pharmacists typically have a full-day or half-day clinic session devoted to patients for the Medicare Annual Wellness Visit. Practices create lists of screening tools and standing orders to be placed based on the health risk assessment and screening findings.
In another example, a nurse-led visit model, the nurse completes the health risk assessment review and screening tests at a visit 4-6 weeks prior to the next physician visit, allowing for the patient to complete the necessary referrals or additional tests in the interim. Shared appointments and inter-professional appointments use the skills of numerous professions to see patients either as a group or individually.
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Annual Wellness Visit Documentation And Coding
A Medicare Annual Wellness Visit is not a typical physical exam. Rather, its an opportunity to promote quality, proactive, cost-effective care. AWVs help you engage with your patients and increase revenue.
A physician, PA, NP, certified clinical nurse specialist or a medical professional under the direct supervision of a physician can perform AWVs.
How To Avoid Medicare Annual Wellness Visit Denials
If youre seeing a high number of denials for Medicare annual wellness visits , youre not alone. Identifying whether to code for an Initial Preventive Physical Exam , an initial Medicare AWV, or a subsequent Medicare AWV can be tricky.
Common reasons for denial include the folllowing:
1. Billing a G0438 or G0439 when the patient has been enrolled in Medicare Part B for 12 months or less. This situation instead calls for billing G0402 .
2. Billing for a Medicare AWV when the patient only has Medicare Part A. They must have Part B coverage as well.
3. Using the wrong primary diagnosis code. If the primary diagnosis code is problem-oriented , Medicare will most likely deny a claim for an AWV, because AWVs are well visits. Instead, list a well code as the primary diagnosis.
The IPPE also has a slightly different set of required components than the two types of AWVs .
Here are some frequently asked questions to help you further navigate the world of AWV billing, as well as a side-by-side comparison of the three types of Medicare wellness visits.
FAQs
Q – What is the difference between a Medicare AWV and a preventive visit?
Q – Can a Medicare patient receive a preventive visit?
Q – Is the IPPE the same as the initial AWV?
Q – What diagnosis code should I use to bill a Medicare wellness exam?
A – Use the Z00 family of codes.
Q – Do Medicare wellness visits need to be performed 365 days apart?
Q – Can I perform a pap smear or pelvic exam during a Medicare AWV?
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What Is Cpt Code G0123
HCPCS code G0123 for Screening cytopathology, cervical or vaginal , collected in preservative fluid, automated thin layer preparation, screening by cytotechnologist under physician supervision as maintained by CMS falls under Screening Examinations and Disease Management Training .
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Center On Aging Care Sheets
The Medicare Annual Wellness Visit is a preventive health benefit for older adults. All beneficiaries enrolled in Medicare Part B for 12 months are eligible for an initial Medicare Annual Wellness Visit followed by a subsequent AWV every 12 months. As part of the Patient Protection and Affordable Care Act, the Medicare Annual Wellness Visit is a co-pay-free visit for patients, and providers are reimbursed at a higher rate for this visit than for traditional office visits.
TIPS FOR THE MEDICARE ANNUAL WELLNESS VISIT
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Contents
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Requirements And Components For Awv
Requirements and components for G0438 include:
- Billable for the first AWV only.
- Patient is eligible after the first 12 months of Medicare coverage.
- For services within the first 12 months, conduct the Initial Preventive Physical Exam , also referred to as the Welcome to Medicare Visit .
What Are The 2022 Cpt Codes For Annual Wellness Visits
Medical reimbursements are tied to Current Procedural Terminology codes. They categorize and specify billing rates and rules for procedures, treatments, and care services.
If youre a medical care provider, you likely know this. But do you know the rates and workflows for Medicares wellness programs? Like, Annual Wellness Visits ?
Knowing the billing codes for AWVs will give you a better idea of whats expected, both by the patient and Medicare.
Understanding billing codes will also help you project revenues and optimize your staffs capacity. Without this information, you risk disorganization and a clouded outlook.
At ThoroughCare, weve worked with more than 600 clinics and physician practices to help them streamline and capture Medicare reimbursements. Our software solution assists with rules and regulations for AWVs, and it tracks all activities related to providing the program, such as conducting patient assessments, making it easier to bill for.
In this article, well briefly review the requirements of AWVs, as well as the programs CPT codes.
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Preparing Eligible Patients For The Annual Wellness Visit
Providers can help eligible patients prepare for their AWV by encouraging them to bring this information to their appointment:
- Medical records, including immunization records
- Detailed family health history
- Full list of medications and supplements, including calcium and vitamins, and how often and how much of each they take
- Full list of current providers and suppliers involved in their care, including community-based providers , and behavioral health specialists
Part B covers an AWV if performed by a:
- Qualified non-physician practitioner
- Medical professional , or a team of medical professionals that a physician directly supervises
When you provide an AWV and a significant, separately identifiable, medically necessary Evaluation and Management service, we may pay for the additional service. Report the additional CPT code with modifier 25. That portion of the visit must be medically necessary and reasonable to treat the patients illness or injury or to improve the functioning of a malformed body part.
You can only bill G0438 or G0439 once in a 12-month period. G0438 is for the first AWV and G0439 is for subsequent AWVs. Remember, you must not bill G0438 or G0439 within 12 months of a previous G0402 billing for the same patient. We deny these claims with messages of, Benefit maximum for this time period or occurrence has been reached and Consult plan benefit documents/guidelines for information about restrictions for this service.
Coding
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How To Bill For Annual Wellness Visits
There are five items required when submitting a claim through CMS:
While its not needed, it is helpful to know the care manager assigned to a patient in case youre ever audited: When billing, youll calculate the time spent with each of your patients monthly.
These are the four steps youll take when billing:
Billing And Coding For The Medicare Annual Wellness Visits
Services provided during all three types of AWVs involve establishing and/or updating patient records with essential vital signs, personal and family health status and history, medications and indications. Physicians can help patients get ready for their AWV by encouraging them to come prepared with the following information:
- Medical Records, including immunization records
- Family health history with as much detail as possible
- Full list of current medications–including calcium, vitamins and over-the-counter productsand dosage and frequency for each
- Full list of current providers and suppliers involved in providing care
Three Visits With Three Sets Of Requirements
1.) G0402 Initial preventive physical examination, face to face with patient, this service is for new Medicare beneficiaries and must be performed within the first 12-months of Medicare Enrollment. This is not a physical exam, even though the physician does measure and record basic vitals, but the patient is also eligible for an EKG screening and aortic aneurism ultrasound if they meet certain guidelines for these services. Often referred to as the Welcome to Medicare Physical, this benefit is only payable once during an enrollees lifetime. If a patient does not take advantage of the Welcome To Medicare visit within their first year of Medicare enrollment, they lose the Welcome Visit benefit, and it can never be recovered.
For more details on EKG and AAU screenings, please visit the CMS website.
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