# Annual Wellness Visit



## PeaPod1

I would really like to hear what the plan is from others as to how your providers' are planning to implement the new AWV(Annual Wellness Visit) into their practices.  Our providers are planning on only providing the minimum requirement to bill the new G codes and absolutely nothing else...  They are going to instruct the patient that even to renew a prescription for a chronic stable condition that they need to schedule a seperate appointment.  My perception of this new benefitm is that Medicare intended this to be a physical and not just the preventive planning portion of this new coverage...

Any thoughts or new office procedures/plans that your facility has taken are greatly appreciated.  I am afraid our plan is going to provide us with plenty of angry elderly...

Thanks so much.


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## sybutler

The following is the link to Medicare's website where you will find Qs&As regarding the AWV.  

http://www.wpsmedicare.com/part_b/education/awv-faq.shtml

One question involves billing for a separate E&M at the same time as the AWV.  Perhaps this might give you some insight into your question and depending on the circumstances, might help eliminate multiple visits by your patients.   

Good luck.

Sue


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## elleyl

The new AWV is focused more on wellness and preventive screening for the Medicare patient.  The requirements only have a "limited" physical that is required.  If you provider decides to do more he/she can.  I would agree to bill any management of a problem in addition to the G code. 

Education to our Medicare patients is going to be important as this AWV is not to be confused with a "complete annual physical."

Linda


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## Lisa Bledsoe

PeaPod1 said:


> I would really like to hear what the plan is from others as to how your providers' are planning to implement the new AWV(Annual Wellness Visit) into their practices.  Our providers are planning on only providing the minimum requirement to bill the new G codes and absolutely nothing else...  They are going to instruct the patient that even to renew a prescription for a chronic stable condition that they need to schedule a seperate appointment.  My perception of this new benefitm is that Medicare intended this to be a physical and not just the preventive planning portion of this new coverage...
> 
> Any thoughts or new office procedures/plans that your facility has taken are greatly appreciated.  I am afraid our plan is going to provide us with plenty of angry elderly...
> 
> Thanks so much.



I have done a TON of research on this topic.  Nowhere in the *"requirements"* does it state anything about a "physical exam" of any kind.  The only *requirement* is BP, weight, height, BMI.  At this point, our clinic is basically looking at doing the same as yours.  And to top that off, we don't accept assignment!  We have angry medicare patients in the billing office all the time.  This is just another huge nightmare that CMS has created.  If they would just pay for preventive visits (99397) there would be no issue what-so-ever.  It's the government way of making the physicians the bad guys.


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## CarolW52

CMS Transmitted 134 (Change Request 7079)  says the AWV will include the establishment of, or update to, the individual’s medical and family history, measurement of his or her height, weight, body-mass index or waist circumference, and blood pressure with the goal of health promotion and disease detection and fostering the coordination of the screening and preventive services that may already be covered and paid for under Medicare Part B.
This appears to be more of an information gathering instruction which will enable the provider to develop a written screening schedule for the individual, such as a checklist for the next 5 to 10 years, as appropriate, including the individual’s health status, screening history, and age-appropriate preventive services covered by Medicare.


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## Lisa Bledsoe

CarolW52 said:


> CMS Transmitted 134 (Change Request 7079)  says the AWV will include the establishment of, or update to, the individual’s medical and family history, measurement of his or her height, weight, body-mass index or waist circumference, and blood pressure with the goal of health promotion and disease detection and fostering the coordination of the screening and preventive services that may already be covered and paid for under Medicare Part B.
> This appears to be more of an information gathering instruction which will enable the provider to develop a written screening schedule for the individual, such as a checklist for the next 5 to 10 years, as appropriate, including the individual’s health status, screening history, and age-appropriate preventive services covered by Medicare.



That is exactly the way we interpret it as well...not a physical at all.


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## PeaPod1

Thanks for all of your responses...  I totally get the no "physical" required part, however just wondering how we are going to spin this to the medicare crowd, to make them think this improves the quality of care they are receiving.  That is going to be the fun part.
Thanks again for the great replies.


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## Lisa Bledsoe

PeaPod1 said:


> Thanks for all of your responses...  I totally get the no "physical" required part, however just wondering how we are going to spin this to the medicare crowd, to make them think this improves the quality of care they are receiving.  That is going to be the fun part.
> Thanks again for the great replies.



LOL - that is what the biggest issue is!  The patients think "Obama-care"/CMS has provided for them to get a "free physical" when they have not.  It's government bureaucracy at it's best.  Again, all CMS needs to do is recognize the CPT codes for preventive care as provided by the AMA and all would be fine.  What's wrong with that?  Oh, I know - it's too simple!


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## valleycoder

*i've gotten my docs on board with the exam by explaining to them this isnt about the chronic conditions or treating anything.  Most patients with chronic conditions come to see our docs every 3 months or so to manage the chronics.  This visit is about focusing on the other areas of a patients wellbeing that are typically not looked at when a patient comes for a sick visit.  

Of course if a patient has a acute condition at this visit, it can be addressed and thats when we charge an e/m as well but our goal is to keep it as an AWV as much as possible.  

We'll see.....*


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## Pam Brooks

We've had to do a great deal of education for our providers (what must be documented to meet the criteria to bill), to our practice managers/office staff (when patients call...this is not a physical), and for our patients....that they not expect a physical.

I developed a FAQ sheet for both my providers (because we use an EMR and our software has yet to be developed to capture the data required by CMS) and patients (because they haven't read the nearly 200 page update that was sent to them in September, that does tell them that this is a risk assessment and not a head-to-toe physical) since our practice managers and front desk staff were getting caught in the middle.  

I'd encourage all of you to organize your practices to be able to provide this service as soon as you are able.  The RVUs are generous.  There is a list of the documentation criteria which can be made into a paper form if you are not on an EMR.  

Instead of complaining about CMS (or the healthcare act) ...I'm grateful.  I will never be unemployed!


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## dballard2004

What ICD-9-CM code would you report with the AWV?  Would you use V70.0?


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## LizM01

*AWV Diag code*

I have submitted my claims with the V70.0 diagnosis code for the G0438 and they are being denied as 'Non Covered diagnosis code", when I contacted NHIC< My MC Contractor> and I asked them to direct me to the documentation that stated what Diagnosis code to use I was informed that they have not received any directions from Medicare as to which diagnosis code to use, and that when they did they would post it on their website.


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## joanmkruse

Medicare members have been told by CMS more than once that the AWV IS an exam.  On Medicare.gov it states "Starting January 1, 2011, Medicare will cover two types of physical exams—one when you're new to Medicare and one each year after that."


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## Cpeterson2010

*G0438*

Medicare says they do not have guidelines stating what Diagnosis to use with the G0438 or G0439.   I am thinking the Routine Exam Code would work:  V70.0.  Just want to be sure because they are so tricky!

What is your opinion on this Pam or anyone out there that has already been paid, etc. 

Thank you!

CP


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## deut649

*can I get a copy*

could you please fax me a copy of what you are using.  I have tried to explain this to my doctors....but they are still trying to do a PE. Ordering bone scans and what not...help please.  my fax is 703-257-6709  thank you


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## racing5302

If at all possible I would also like to get a copy of what the other person is using as well.  If you could email me what you are using for the Dr's that would be much appreciated.  thank-you

amy.miller@lmh.org

Amy Miller, CPC


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## KSHUFELT

*Share*

Pam,

Would you be willing to share your FAQ sheets?

Kim Shufelt, CPC
Seton Health 
Director of Primary Care Business Operations
Troy, NY


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## Lorisvg

The link for the FAQ didn't work


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## donna_vig

Medlearn Matters has wonderful material on the Well Visit HCPC codes and the ICD9 codes.  Visit the CMS website and look for the MLMatters link.


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## judweber

Pam Brooks said:


> We've had to do a great deal of education for our providers (what must be documented to meet the criteria to bill), to our practice managers/office staff (when patients call...this is not a physical), and for our patients....that they not expect a physical.
> 
> I developed a FAQ sheet for both my providers (because we use an EMR and our software has yet to be developed to capture the data required by CMS) and patients (because they haven't read the nearly 200 page update that was sent to them in September, that does tell them that this is a risk assessment and not a head-to-toe physical) since our practice managers and front desk staff were getting caught in the middle.
> 
> I'd encourage all of you to organize your practices to be able to provide this service as soon as you are able.  The RVUs are generous.  There is a list of the documentation criteria which can be made into a paper form if you are not on an EMR.
> 
> Instead of complaining about CMS (or the healthcare act) ...I'm grateful.  I will never be unemployed!


Is there any you would be willing to share the FAQ sheet you developed?  I am searching for a user-friendly template to provide our physicians with in order to comply with CMS.  Any help you could provide would be appreciated.


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## Sjburke3

*Billing AAA screening with AWV*

Has anyone billed the AAA screening G0389 with an AWV or Subsequent AWV?  The policy states it needs to be as a referral from IPPE, but what about the patients who have been on Medicare and "jump in" at the AWV level???  I'm wondering if is still payable if scheduled as the result of an AWV.  Thanks.


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