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Showing posts with label Annual Wellness. Show all posts
Showing posts with label Annual Wellness. Show all posts

Annual Wellness Visit (AWV) - Medicare

 HCPCS/CPT Codes

  • G0438 – Annual wellness visit; includes a personalized prevention plan of service (PPPS), initial visit
  • G0439 – Annual wellness visit, includes a personalized prevention plan of service (PPPS), subsequent visit

Who Is Covered

All Medicare beneficiaries who are both,

  • Not within 12 months after the effective date of their first Medicare Part B coverage period
  • Have not received an Initial Preventive Physical Examination (IPPE) or AWV within the past 12 months

Frequently Used ICD

  • Z00.00 - Encounter for general adult medical examination without abnormal findings
  • Z00.01 - Encounter for general adult medical examination with abnormal findings
  • Z00.121 - Encounter for routine child health examination with abnormal findings
  • Z00.129 - Encounter for routine child health examination without abnormal findings

Frequency

  • Once in a lifetime for G0438 (first AWV)
  • Annually for G0439 (subsequent AWV)

Medicare Beneficiary Pays

  • Co-payment/Coinsurance waived
  • Deductible waived

Annual Preventive and Wellness Visit Service

Preventive Service Codes


The annual preventive exam is a periodic, comprehensive preventive medicine evaluation (or reevaluation) and management of the patient.

The CPT Code selection is based on whether the patient is receiving an initial visit -"New Patient" or a periodic - "Established Patient" preventive service, as well as the patient’s age.
  • Initial Visits - 99381, 99382, 99383, 99384, 99385, 99386, 99387
  • Subsequent Visits - 99391, 99392, 99393, 99394, 99395, 99396, 99397
The Medicare insurance would be covered by "G" codes instead of the above codes. The details below,
  • Welcome to Medicare - G0402 (Within the one year from the patient enrolled in Medicare)
  • Initial Annual Wellness Visit - G0438 (After the 1st year of enrollment)
  • Subsequent Annual Wellness Visit - G0439

Initial Visits


Initial comprehensive preventive medicine evaluation 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", New patient,
  • 99381 - Infant (age younger than 1 year)
  • 99382 - Early childhood (age 1 through 4 years)
  • 99383 - Late childhood (age 5 through 11 years)
  • 99384 - Adolescent (age 12 through 17 years)
  • 99385 - 18-39 years
  • 99386 - 40-64 years
  • 99387 - 65 years and older

Subsequent Visits


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,
  • 99391 - Infant (age younger than 1 year)
  • 99392 - Early childhood (age 1 through 4 years)
  • 99393 - Late childhood (age 5 through 11 years)
  • 99394 - Adolescent (age 12 through 17 years)
  • 99395 - 18-39 years
  • 99396 - 40-64 years
  • 99397 - 65 years and older

Included Services


Checking the status of "chronic conditions" and "refilling ongoing prescriptions" is expected during an annual preventive exam and does not warrant the billing of a separate problem-oriented E/M service.

If a chronic condition is not being well controlled, however, and decisions are being made as to how to treat the patient to improve control (changing the dosage of medications, changing to a new medication, etc.), this may substantiate a separate problem-oriented E/M service.

Documentation

  • Medical and family history
  • List of current medical providers
  • Height, weight, BMI, BP, and other appropriate routine measurements
  • Detection of cognitive impairment
  • Review risk factors – Review of functional ability
  • Establish a written screening schedule for the next 5-10 years
  • Establish a list of risk factors
  • Provide advice and referrals to health education and preventative counseling services

Tips - CPT G0402 & G0438 covered once in a lifetime for the patient.



See E/M 2021E&M guidelines

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