Annual Wellness Visit Codes


New Medicare Wellness Benefits

Medicare has added a new benefit as part of the healthcare reform bill and has added a preventive medicine service on a routine basis for beneficiary outside of their first year of having their IPPE.

So after they have that IPPE, they can come in and have a covered annual wellness visit. This is a huge benefit. A lot Medicare carrier beneficiaries have been requesting these preventive medicine for years especially do evaluate their chronic and ongoing conditions which right now in a most recent survey was approximately five conditions evaluated at every Medicare beneficiaries preventing medicine service.

Now, this visit will include a health risk assessment and the physician will also be creating a personalized prevention plan. That plan will include seven different items including establishing or updating the individual’s medical family history. This may just be updated from the past information that was there.

Healthcare Training Tip: Make sure that that documentation is supported that that exists in the chart and where, a list of the medications prescribed for that individual, vitals. Also it will include a screening scheduled for the next five to ten years or any detection of any cognitive repair impairment.

The advanced care planning is voluntary. So this was proposed as an addition, last year, there was some confusion as to whether it was required component or not. It is voluntary to discuss these items.

In addition, a depression screening and functional status screening are included at the first annual check. The new codes will be at about the level of a 99214. The G0438 is what you will report for the first visit. After that, you'll be reporting the G0439. So this is the code you would use in the second year. So the first year, the patient will come in. It'll be with the IPPE. If you are maintaining that same patient, then that second year, when they return, you would be reporting that subsequent visit.

The interesting thing is that you can report an E/M 25 service on the same day which is great news considering how many chronic conditions the Medicare beneficiary will have to be able to report the preventive medicine service code for the preventive medicine service work and still report the E/M 25 for additional time spent on treating and managing those chronic conditions.

Medical coding and billing Update : Interestingly, this benefit is not subject to incident-to rule. You would report it under the supervising physicians and PI but it only requires physician direct supervision. The actual benefit may be performed by a team of medical professional working under that physician supervision. So this is a good area for you to look at having your LPN and RN to work on in order to optimize your family physician’s time.