Medicare Wellness Visits: Documentation Guidelines and Coding Tips

If you are in the primary care world, it is no secret that Medicare Wellness Visits are performed in the office setting. Did you know that there are strict documentation guidelines? Just how strict are they? Where do I find the documentation requirements? It’s the same as a preventive medicine visit, right? If you want to find out, join us for a session filled with documentation guidelines, tools, educational tips for providers and coders, and potential denial areas.

Learning Objectives/Agenda

• What is the difference between preventive medicine services and Medicare Wellness Visits.
• When a patient becomes eligible for the Medicare Wellness benefit.
• What are the documentation components for each type of Medicare Wellness Visits, and CMS approved tools.
• Medicare Wellness coding tips, including Rural Health.
• Other preventive services that can performed in conjunction with the Medicare Wellness Visits.

Why is this topic important?

AWVs are not like regular evaluation and management or preventive medicine services from the prospective of new versus established patients; they are billed based on how long the patient has been effective with Medicare Part B. AWVs are included under preventive services to Medicare beneficiaries in lieu of preventive medicine services covered by other payers. The biggest difference lies in the documentation requirements; if any of the requirements are not documented in the medical record, then the AWV not billable.

Through auditing thousands of AWV across hundreds of providers, we know these visits are a huge cause of denials due to lack of understanding. This comes from three places: coders and providers not recognizing documentation requirements, ill-informed of correct coding, and also deficient in awareness that preventive medicine services and AWV serve two different purposes. It is common knowledge in the primary care world that Medicare does not accept preventive medicine CPT® code range 99391-99397, but since AWV is lumped into that preventive medicine bubble, many providers and coders who are not trained believe the code changes because it is a Medicare patient without expertise in the change of purpose and documentation.

Who would benefit from this topic?

• Medical coders
• Medical billers
• Providers
• Physician educators
• Practice managers
• Medical auditors

What’s the presenter's background/expertise on this topic?

In my previous role, I was a medical coding lead for the second largest hospital in Indiana. An enormous piece of my job role involved Medicare Wellness Visits. From educating physicians and APPs on documentation and coding, to teaching coders how to audit these visits for accuracy and completeness.

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