Billing Wellness Visits Under Medicare, Part II

July 17, 2023 Last week, we delved deeper into the first of three types of wellness visits—IPPEs—covered by Medicare. Now, let’s do the same for the second category: Annual Wellness Visits (AWVs).

AWV (Annual Wellness Visit)

Like the Initial Preventive Physical Exam, there’s a timing component to the AWV. The annual wellness visit (AWV) must take place within 12 months of the IPPE to be covered. Here’s what’s involved in an AWV:

• Perform a health risk assessment. At a minimum, this should include:
  • Obtaining the patient’s self-reported information (a questionnaire the patient fills out) from the IPPE. You or the patient can update this before or during the AWV.
  • Collect the following patient information:
    • Demographic data
    • Health status self-assessment
    • Psychosocial risks, including depression, life satisfaction, stress, anger, loneliness, social isolation, pain, and fatigue
    • Behavioral risks including tobacco abuse, physical activity, nutrition, oral health, alcohol consumption, sexual health, seatbelt use in a car, and home safety
    • Ability to manage activities of daily living (ADLs): dressing, feeding, toileting, grooming, physical ambulation (balance, fall risks), bathing, using the phone, housekeeping, laundry, transportation, shopping, managing medication, and handling finances
    • Medical events of the patient’s immediate family and health risks
    • Past medical/surgical history
    • Use or exposure to medications and supplements
      • • Current providers and supplier lists
        • Measurements (height, weight, body mass, and blood pressure)
        • Detect any cognitive impairments
        • Identify potential depression risk factors.
        • Assess the patient’s functional ability and safety levels.
          • Evaluate the ability to perform ADLs, fall risk, hearing impairment, and home safety.
        • Establish a patient-written screening schedule for the next 5-10 years.
        • Develop a patient list of risk factors and conditions.
        • Provide personalized patient health advice and referrals for health education or preventive counseling.
        • Community-based lifestyle interventions to reduce health risks and promote self-management and wellness, including:
          • Fall prevention
          • Nutrition
          • Physical activity
          • Tobacco use cessation
          • Weight loss
          • Cognition
        • Offer Advance Care Planning (MOLST, DNR/DNI) if the patient agrees.
        • Review current opioid prescriptions.
        • Screen for potential substance use disordersEstablish the patient’s medical and family history, including:

      Coding for AWVs

      The code for AWVs is GO438. If you also perform a mental health screening that meets the requirement of 9 questions answered, use GO444 (59). You can bill MOLST (99497) as well.

       

    • Here are the complete CMS guidelines for AWV visits: www.cms.gov/Outreach-and-Education/Medicare-Learning-NetworkMLN/MLNProducts/preventive-services/medicare-wellness-visits.html
      

      In Part III, we will discuss Subsequent Wellness Visits (SWVs) 

       

      Download PDF

      Michelle Sergei-Casiano CPC, CFPC, CEMC Senior Manager, Regulatory and Coding Compliance coders@calmwatersai.com