Three steps to coding for Medicare wellness visits

To ensure that your coding and documentation accurately capture the significant relative value units (RVUs) and revenue associated with Medicare wellness visits, follow these three steps:

1. Code for the wellness visit. An initial preventive physical exam (IPPE, or Welcome to Medicare visit) is a one-time physical exam performed within the first 12 months of a patient’s Part-B enrollment. An initial annual wellness visit (G0438) can be provided 12 months after the patient first enrolled or 12 months after he or she received the IPPE. A subsequent annual wellness visit (G0439) can then be provided annually. Each has its own documentation requirements.

2. Code for any additional separately billable preventive services you provided. A list of these services, including information about coinsurance and deductible requirements, is available here. Be aware that some have time requirements (e.g., several separately reportable behavioral counseling codes require at least 15 minutes).

3. Append modifiers as needed to avoid bundling. If you provide advance care planning in addition to an annual wellness visit (it is not billable with the IPPE), append modifier 33 to the advance care planning code. Check with your Medicare contractor to learn what they require.

Read the full FPM article: “Medicare Wellness Visits: Reassessing Their Value to Your Patients and Your Practice.”

Posted on Apr 26, 2019 by FPM Editors