# Physical, Medicare AWV, and office visit



## Radcoder86 (Jun 19, 2015)

If a patient comes in for a physical, plus the doctor does the Medicare AWV, and the patient is also seen for a separate issue, how would I code this?
9939725, G0438, and 99213? Is this allowable?


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## JesseL (Jun 19, 2015)

I don't know and not really familiar with this stuff but I know medicare doesn't pay for annual physicals.  i would tell the provider to not do everything at once because I would assume most insurances wouldn't pay for two preventives done on the same day, especially if they only cover one preventive per a year.


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## Radcoder86 (Jun 19, 2015)

Well, they have a medicare advantage plan that will pay for the physical plus the wellness, but I've never had to bill for a regular office with those. The provider should have had the patient schedule another appointment, but he didn't.


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## JesseL (Jun 19, 2015)

Radcoder86 said:


> Well, they have a medicare advantage plan that will pay for the physical plus the wellness, but I've never had to bill for a regular office with those. The provider should have had the patient schedule another appointment, but he didn't.



Pretty difficult to bill since both preventive codes have some of the same components of each other.  The AWV just doesn't have any physical component I believe.  I'd probably put modifier 25 on all 3 codes and hope for the best, at least that's what I would do and see if they deny it.  You might even want to call the insurance plan to see if they'd even cover annual physical and wellness done on the same date.


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## lgardner (Jun 22, 2015)

Radcoder86 said:


> If a patient comes in for a physical, plus the doctor does the Medicare AWV, and the patient is also seen for a separate issue, how would I code this?
> 9939725, G0438, and 99213? Is this allowable?



yes. this is allowable.
you want to add a -25 mod on both the preventive and the e/m.

you may be able to get a 99213 for an established patient, if there is enough, clearly specific, information in the ROS and exam...but make very sure that you can pull the elements needed for each service...DO NOT double dip. if you count something for the E/M do not count that for the preventive visit.

the AWV is allowable with the preventive because there are no requirements for an exam, but, again...make sure that anything you are counting towards the AWV is not counted towards either of the other services. 

and make sure that there is a separate chief complaint for the office visit.


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## annielou (Jun 25, 2015)

*AWV and OV*

We normally bill a 99213/25 with the AWV code. The dx for the AWV is V70.0. We only bill a 99213 because so much of the HPI is covered under the AWV. It helps to pull in a separate note for one of the medical conditions in the EMR. Medicare and the Advantage plans all pay on this.


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## Radcoder86 (Jul 9, 2015)

lgardner said:


> yes. this is allowable.
> you want to add a -25 mod on both the preventive and the e/m.
> 
> you may be able to get a 99213 for an established patient, if there is enough, clearly specific, information in the ROS and exam...but make very sure that you can pull the elements needed for each service...DO NOT double dip. if you count something for the E/M do not count that for the preventive visit.
> ...




Where can I find guidelines that I can show my supervisors about needing separate documentation if the docs want to bill a separate E/M? I have talked to them about how we shouldn't double dip and that there needs to be separate documentation in order to bill an E/M, but they are telling me that isn't the case and I can bill a separate E/M as long as they aren't chronic conditions. I'm in a difficult situation.   If I can show them some guidelines regarding this it would really help me, but I can't find any.


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## lgardner (Jul 9, 2015)

here is something from CMS that shows you can bill an E/M with an AWV/WTM:

http://www.cms.org/uploads/NewMedicarePreventiveServices.pdf

here is something from United Healthcare Medicare Advantage (the only advantage plans my practice accepts) which includes info on billing a WTM/AWV with a preventive visit as well as billing an E/M with the above:

https://www.unitedhealthcareonline....e/2015_Medicare_Advantage_Annual_Wellness.pdf

good luck.


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## marcieadasher@gmail.com (Jul 29, 2015)

*Medicares AWE, IPPE CPT CODEs ????????*

For the Medicare AWE, IPPE are we to bill the actual preventive cpt code 99387or 99397 or are to use the regular OV E/M codes. I know the G codes are to be billed. Just need clarification if we also bill OV 99213-99215 codes or the preventive exam 99387-99397.

Thanks


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## Radcoder86 (Aug 13, 2015)

There are different G codes for the AWV and IPPE. I did try billing an office visit, physical, and AWV together with a modifier on the physical and office visit, and they were all paid.


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## bkudsk (Aug 19, 2015)

*Preventative exams*

Preventative exams are not a Medicare benefit.  Only the IPPE's and AWV's are and they must be supported by all the elements/requirements of the IPPE and AWV's before you can submit a claim.


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