There are no required ICD-9 codes for use of the G-code. Meaning you could submit any ICD-9 code or codes including a V-code as the ICD-9. And the G-code is the CPT code you submit with it. Don't forget, you can also do an EKG (required with Welcome to Medicare) but optional with Annual Wellness Visit and it too has a G-code. Other screening labs and tests may be covered based on patient's risk factor(s). I have made a paper template that is not part of amazing charts (a real piece of paper in my office) because part of the requirement of the annual wellness visit is a personal plan of prevention (or some clever title like that). You must also test cognition, and the test as defined is to recall three words at 5 minutes. I use ROSE, HAT, CARROT (ergo, R H C at 5 minutes). You also have to ask about Advanced Directive (don't have to do more than ask) - we do refer patients to Texas Hospital Association website (each state has its own forms) and for those who are not web saavy we have some pre-printed blanks they can go home with.
At the bottom of my form are the two most common G code (to job my memory - will likely not appear on my next revision of this form). And the paper is given to the patient and the information on it is put into AC by my MA (vitals, vision, Zung score, etc) or in plan section by me (when shots/screenings are due). Do with this as you choose. Good luck!
Annual Medicare Exam
List all other healthcare professionals you are seeing:
____________________
Today?s numbers:
Blood Pressure:________________________
VISION TEST: Left____________ Right____________
Height__________________Weight_______________BMI____________ (goal is 20-25)
Please fill out Zung (or other) depression screener and attach. Screen: R H C @ 5 min.
Date of last PNEUMOVAX:____________recommended once after age 65
Date of Tetanus-Diphtheria-perttussis:__________recommended every 10 years
Date of last flu shot___________________recommended yearly
Date of last Mammogram (if applicable)_______________ recommended yearly
Date of last PSA blood test (if applicable)________________recommended yearly
Date of last Bone Density Test________________________recommended every 2 years
Date of last Colorectal Cancer Screening________________
Due for next one_________________
Do you have an Advanced Directive Y N
If you smoke. You should stop. Smoking increases risk of death, heart attack, stroke, and cancers.
First Annual Wellness Visit G0438, subsequent AWV G0439
