Wiki Medicare Annual Wellness Visit - My practice has never billed

[jenn13088]

My practice has never billed for the Medicare Annual Wellness Visit and one of our providers was told by another provider in our community that they bill for the annual wellness visit AND the a physical (using an E/M office code) on the same day with mod.-25.

Per the Medicare Learning Network article ICN 905706 January 2014 FAQs:
Can I bill a seperate E/M service st the same time as the AWV?
"Medicare may pay for a significant, seperately identifiable, medically necessary E/M service you bill at the same time as the AWV with modifier -25.
That portion of the visit must by medically necessary to treat the beneficiary's illness or injury, or to improve the functioning of a malformed body member."

I would interpret this as "NO", only an acute visit would be billable when medically necessary. A physical would not fall into this scope. Does anyone else agree??

 

[philipwells]

Agreed

 

[pezztx]

For a physical, are you meaning the PM code like 99397? If so, Medicare does not cover that code. My providers commonly charge a Wellness Visit (g code) and an established level visit, to which I append the -25 to the office visit.

 

[mitchellde]

For a physical, are you meaning the PM code like 99397? If so, Medicare does not cover that code. My providers commonly charge a Wellness Visit (g code) and an established level visit, to which I append the -25 to the office visit.

If the patient presents for a wellness visit , the what is the established visit level for?

 

[jenn13088]

My provider was told that he could bill the "G" code and an E/M (99213-99215) with the mod 25 with every "G" code. I disagree based upon the Medicare FAQs answer. I interpreted Medicare's response as it having to be medically necessary. I would not consider a "physical" "medically necessary to treat the beneficiary's illness or injury, or to improve the functioning of a malformed body member."

Am I off-base here?

 

[philipwells]

Nope you're on base. If there is not an illness/problem identified at the time of the visit then you can't bill for the E&M.

Now if the physician diagnosis the patient with some type of illness at the time of the physical then bill the E&M with a 25 modifier. With the illness diagnosis being the primary dx for the E&M and of course the v-code/routine dx being the primary for the physical.