Get More Information on Annual Wellness Visits

Get More Information on Annual Wellness Visits

Clue: You can perform annual wellness visits on just in patients

Part B practices on the lookout for answers about the new annual wellness visit (AWV) services that Medicare allows in 2011 have come up short, with Centers for Medicare & Medicaid Services (CMS) still waiting to release wide ranging coding guidance on the matter. However MACs have gone on to share answers to the frequently asked questions (FAQ) that they have received on the topic and we have got a few of the answers to help you ensure that your G0438-G0439 claims process goes smoothly.

First question: Can we collect for an annual wellness visit that we perform on a patient we have never met before?

Well, the answer is yes. According to WPS Medicare notes on its website, there is no regulation the patient has to be established. The MAC, which is a Part B payer in four states indicates that if the patient had an AWV at another practice during a previous year, you will go for G0439 (AWV, includes a personalized prevention plan of service [PPPS] subsequent visit) for your service. If the patient never had an annual wellness visit prior to this, you will bill G0438 (first visit).

Second question: What type of documentation that Medicare need for recording the annual wellness visit?

Well, you will want to document the AWV the same way you document all other services that your practice carries out meticulously and carefully.

As per a directive on the website of Trailblazer Health Enterprises, a Part B payer in five states, "Physicians, qualified non-physician practitioners and medical professionals are required to use the 1995 or 1997 E/M documentation guidelines to document the medical records with the proper clinical information.

All referrals and a written medical plan should be covered in the documentation.

Third Question: Is G0438 a "once in a lifetime" code?

Well, yes you can report G0438 only once per beneficiary. According to Pinnacle Business Solutions, a Part B MAC in two states, if you submit a claim for G0438 and Medicare has already covered that beneficiary for another instance of that code, you will get an explanation of benefits (EOB) with claim adjustment reason code 149 (Lifetime benefit maximum has been reached for the service/benefit category).

For more on this and for other Part B Insider news and views, stay tuned to a good medical coding resource like Supercoder.

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