Medicare's Annual Wellness Visit: Tips for Your Practice

What would success look like for a medical practice that performed Medicare's annual wellness visits (AWV)? How about satisfied patients scheduled for recommended screening services, and increased practice revenue? After initially disdaining the service because it did not correspond to a typical preventive medicine visit, many groups now see it as an opportunity to discuss preventive medicine and health habits with Medicare patients, and to be paid for doing so.

Steps to success

However, this type of success does not automatically follow the decision to offer the AWV. A practice needs to be sure it understands the unique coding requirements and visit components. Before you begin, review the coding requirements which are described in this article and in CMS's online resources. Practices should then develop a paper or electronic template that documents the components of the AWV. Be aware that a typical preventive medicine template will not meet these requirements. Many specialty societies have developed such templates; it is advisable to check first, rather than starting from scratch. In 2012, the AWV requires a patient-completed Health Risk Assessment to be done prior to the patient visit. A staff member can obtain much of the other screening information needed for the visit.

The next step is to set-up new "visit types" in your schedule for the Welcome to Medicare Visit, the initial AWV, and the subsequent AWV; make sure you have the correct amount of time allotted for each type of visit. Many groups schedule 20 minutes to 40 minutes for the Welcome to Medicare and initial AWV, with less time for the subsequent AWV, but this varies. It is key that the patient is scheduled for an AWV and not a physical exam in order that the correct template is prepared for the provider. This also prevents unpleasant surprises for the patient, such as: "But that was my free Medicare exam and you've billed me for it!"

The following are the key components for each type of visit:

Welcome to Medicare Visit or Initial Preventive Physical Exam

Patients are eligible for the Welcome to Medicare visit in the first 12 months of their enrollment in Medicare, and it may be performed by either a physician or nonphysician practitioner. It requires:

• Review of medical and social history

• Review of potential for depression (using an accepted screening tool)

• Review of functional ability and level of safety

• Height, weight, BMI, BP, visual acuity screening, and other factors as appropriate

• Discussion of end-of-life planning, with patient permission

• EKG is optional (Use G0403 not 93000)

• Education, counseling, and referrals based on results of review and evaluation services performed during the visit - including a brief written plan such as a checklist, and if appropriate, education

Initial Annual Wellness Visit G0438

A patient is eligible for the initial AWV if he has been enrolled in Medicare for over 12 months, and has not received the Welcome to Medicare visit within the past 12 months. This visit requires:

• A patient-completed health risk assessment

• Medical/family history

• List of current providers/suppliers of medical care

• BP, height, weight, BMI calculation, or waist circumference measurement

• Detection of cognitive impairments

• Review of functional ability and safety

• Establishment of a written screening schedule for the next 5 years to10 years

• List of risk factors and conditions for which treatment is recommended

• Personalized health advice and referrals for health education and preventive counseling

The health risk assessment is new for 2012. CMS believes that a self-assessment tool can be completed by the patient prior to the visit in about 20 minutes. It should address demographic data, self assessment of health, psychosocial risks, behavioral risks, and activities of daily living.

Subsequent Annual Wellness Visit G0439

A patient is eligible for a subsequent AWV 11 full months after the previous AWV. The requirements are to update the same components that are listed for the initial AWV.

Any diagnosis is acceptable, such as V70.0. These visits are not defined as a new or established patient. CMS states that nonphysician practitioners should bill these services under their own provider numbers; not incident-to a physician service, under the physician's provider number. Other services that may be billed and performed during the same day include: a separate and distinct problem-oriented office visit, and other preventive services such as the pelvic and breast exam. If a problem-oriented visit is billed, no part of the documentation for the Welcome to Medicare or AWV may be used to select the level of service. The pelvic and clinical breast exam and obtaining a Pap smear may be billed, if performed and documented, using codes G0101 and Q0091.

As always, review the complete code descriptions and frequency limitations before billing for any service. A typical preventive medicine exam, in the 9938X-9939X series of codes remains noncovered; you should obtain an Advanced Beneficiary Notice and bill the patient directly for that service.

Patients have come to expect these wellness services. Plan for them, schedule them with the correct visit type, and open the appropriate template when the patient arrives. Finally, be paid to talk to Medicare patients about wellness, prevention, and health.

Betsy Nicoletti is the founder of Codapedia.com. She is the author of "A Field Guide to Physician Coding." She believes all physicians can improve their compliance and increase their revenue through better coding. She may be reached at betsy.nicoletti@gmail.com or 802 885 5641.