Now, after the year has gone by and we go for the Initial Annual Wellness Visit, this
is more extensive and it builds on the G0402.
Now, if the patient never showed up in that year, you would combine part of the G0402
with the G0438 because you really are building up quite a database on this patient.
So, on this visit, you’re establishing the beneficiary’s medical and family history.
You’re establishing the list of current providers and suppliers that are regularly
involved in providing medical care to the individual.
Once again, you’re measuring height, weight, body mass index, blood pressure, and other
routine measurements deemed appropriate based on the medical and family history.
The physician will detect any cognitive impairment, review risk factors for depression (past and
present) and mood disorders.
They’ll review functional ability and level of safety.
And then they’ll write a screening schedule and a checklist that just span 5-10 years.
As you can clearly see, this is not a complete checkup; this is really just an overview and
really establishing the patient’s medical history.
And then the doctor will establish the list of risk factors and conditions, furnishes
personal health advice and a referral, as appropriate, to health education and counseling.
Even refer a mental health provider, anything of that nature.
And then any other elements determined appropriate by Secretary of Health & Human Services through
NCD (National Coverage Determination).
On the third visit, the Subsequent Annual Visit (G0439), this one is just basically
updating everything from G0402 to G0438, and you’re just building and making changes
and monitoring and keeping up-to-date with the new providers, any hospitalizations they
may have had, anything like that.
It has nothing to do with 99387, a new physical exam for patient, or 99397 established.
If you go the cms.gov website, you can really see how these visits work and what’s involved,
and it will tell you that you can bill a medical necessity visit if something happens along
the lines of while you’re visiting the patient and there is a health issue or concern.
Again, when I say the 99387 or 99397, you could certainly bill that at another time,
that will not get paid.
If you bill a pap or pelvic exam with that, they will get paid.
And believe it or not, the reimbursement for pap and pelvic exam, if you need the criteria
as well as the breast and pelvic and the pap reimbursement depending on where you are,
is anywhere like from $75 to $80.
Even if Medicare does not pay for the checkup you’re still making decent money on that
other part of the exam.
Typically, what providers do and Medicare suggest is that there is an allowable rate
linked to the 99387 or 99397 and Medicare will pay for the pap or pelvic, or any other
lab test or procedures that are considered allowable for the visit.
And you can bill the patient the allowable amount if you wanted to.
But, usually, when you get to be 65, the patient usually has something wrong with them, and
so, the doctor has a tendency to use an E/M and then do the screening for the pap and
pelvic.
The rules being with these two codes, is that it’s every two years; but if it’s high
risk, it can be every year, and there are specific diagnosis codes that go with that.
Also, be aware, depending on how you’re coding, if it’s for the Welcome to Medicare
and the Annual Wellness Visits or the medical necessity or the preventive physical checkups,
make sure that you understand about the advance beneficiary notices that need to be signed
and the modifiers that go with that and know where to link the modifiers like -25 or -59
if that’s necessary if you want to get paid, and the correct coding initiative or any of
the websites, like, SuperCoder.com, FindACode.com will tell you what modifiers are acceptable
and what you can and cannot bill with.
Again, those G codes have nothing to do with the 99387 or 97 and it is very confusing for
doctors.
I think they get it now because it’s been around a while, but it was a nightmare in
the beginning, they just didn’t get it.
That’s pretty much that.
Oh, but I do tell you, there is a beautiful chart on CMS.gov that has everything, every
preventive visit, every CPT or HCPCS code, diagnosis codes that are associated with it,
and how often you can have it, like, say a screening for depression is once a year, that
type of thing.
It gives you all the information you need, and as long as you have the document, the
record, then you should be okay.
That’s it.
I hope that wasn’t too confusing.
It is very confusing to even try to bill for it because doctors usually get it wrong, but
I don’t know, we’ll see.