Primary Care Coding Alert

Question: Does the Medicare annual wellness visit (AWV) include the provider discussing and treating a patient’s chronic conditions, or should I bill a separate evaluation and management (E/M) service for that?

Answer: The Medicare AWV has specific requirements and documentation. Those requirements don’t include treating a patient’s chronic conditions, so it’s best to bill each separately. Remember though that both the AWV and an E/M need to have sufficient supporting documentation, so be sure the notes satisfy each portion and that they’re clearly labeled in different sections of the notes.

If the AWV and problem-oriented E/M code are being reported under the same provider number, you will likely need to append modifier 25 (Significant, separately identifiable evaluation and management service by the same physician or other qualified health care professional on the same day of the procedure or other service) to show that the services were separate from each other. This is consistent with CMS billing guidance. (Source: https://www.cms.gov/Outreach-and- Education/Medicare-Learning-Network-MLN/MLNProducts/ preventive-services/medicare-wellness-visits.html)