Home Forums Discussions Feedback and Recommendations New Medicare Annual Wellness Visit

A new 2011 Medicare benefit is an "Annual Wellness Visit" (AWV), which is available to patients (once on Medicare B for at least 12 months), and updated once every 12 months. The goal of this visit is to develop a "Personalized Prevention Plan of Service" (PPPS), which is a written health risk assessment and recommendations for screening and counseling. It does not replace a periodic exam, and actually does not include an examination by a physician.

This is the annual version of the "Welcome to Medicare" visit that was introduced last year for patients within the first 12 months of getting on Medicare B.

I have already had a few inquiries from patients, I am sure there will be more once Medicare and AARP starts notifying patients. The patients don't have any cost if their doctor accepts assignment, which should make the AWV popular. The Medicare approved for doctors in my area is below:
-- "Welcome to Medicare" (G0402) - $148.92
-- Initial "Annual Wellness Visit" (G0438) - $161.85
-- Subsequent "Annual Wellness Visit" (G0439) - $106.68
-- compared to: Level 5 OV (99215) - $139.16

The checklist for what is covered in these visits is lengthy, but much the same for all patients; ideal therefore for a template to aid documentation.

SO: Has anyone thought about or even written a template? How would it fit into an AC encounter (maybe an addendum?) When will the "G codes" above be added to AC?

John I have at least thought about creating a template, but have not had time to make one. As you have pointed out there are criteria that must be fulfilled for both the Welcome to Medicare visit and the AWV. I don't do enough Welcome to Medicare visits to justify building a template, however we do tons of annual visits that were previously coded as 99214 or 99215. The reimbursement is a little better on the AWV and I would love to build a template when I have time to do so.

I would build a template for the "Plan" section of the note which has standardized language speaking directly to the AWV requirements.

This is what I am trying to do as well, making it as individualized & customizable as I can. These visits are specifically for planning...not exams, so I am likely going to use an addendum template.

Does anyone know the diagnosis or ICD 9 codes for these
1. Welcome to Medicare
2. Initial ' Annual Welcome visit"
3. Subsequent " Annual Wellness visit
Grenville

Please someone share a template. I have delayed doing the Medicare annual wellness benefit thing for now because of the end of life counseling ie "death panel" fiasco code which lasted just 4 days.

I listed them above in my first post. They are "G-codes".

Thanks John
I thought they were CPT codes !

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

Oh! The form contains all the required elements of the Annual Wellness Visit: Other docs patient is seeing, BP, weight, height, BMI, vision, depression screener, prevention plan, smoking cessation counseling.
AND - as a side note, if patient asks for med refills or you address a problem during exam, you can bill for office E&M code in addition to the G-code which covers the prevention (and other required stuff) only.

Great work Alberto.

Is this true, without decreasing reimbursement? How did you find this out?

So I can take my existing Medicare patients, fill out this form, and just this, list the G code visit and get reimbursed?

I do think you are supposed to have the visit with them as well.

Well yes, that would be good. I do my own coding, so I want to make sure this is all I need in the visit (can I take your word for it?) before I code it this way and send it off to billing.

The required parts of the annual wellness visit include a FACE TO FACE visit which includes a PHSYCIAL EXAM, a review of their medical problems (already in PMH for your established patients, I hope), review of family health history (should be in AC), review of medications (again in AC and up to date, ideally), a review of docs they currently see (on form) and the elements on the form (ht, wt, BP, BMI, vision, depression screening, assessment of cognition) including the personalized primary prevention plan (the bulk of the form to include: immunizations, cancer screening, other screenings as warranted) a copy of which goes home with them - smoking cessation, and asking if they have an advanced directive (not a requirement to give them one or fill it out - only to ask). All this information is on medicare's website. (easier to find on medicare.gov than cms.gov). Covered preventative services are found at http://www.medicare.gov/navigation/...ervices/preventive-service-overview.aspx ALSO, the "old" welcome to medicare exam required an EKG - the annual wellness visit makes no mention of an EKG. Adding a problem level visit on top of the G code for the exam should not reduce the reimbursement of your G code, but you may check with your medicare intermediary (we use Trailblazer in TX). As for coding - no need to take my word for it - I'm just a lost doctor working my butt off and stumbling through insurance red tape and costly mistakes - just like the rest of you. But you can follow my lead and be just as lost, or scour the rest of the internet and read the electronic bulletins CMS puts out (which clog my email inbox). ACPE (American College of Physician Executives) puts out a nice summary that comes in the email daily and is a benefit to members (and if you own your own practice as I do - you may find it beneficial). Medscape also has some nice free resources that come in the e-mail and AAFP. I have not found any of my osteopathic societies to be nearly as helpful. But more on that in another venue....
I hope this helps. And good luck!

Thanks for the info and web link. It filled in some gaps for me. Would you please elaborate on the American College of Physician Executives. Thanks.

There is a nice complete 6 page pdf chart form (with patient handout re: personalized primary prevention) made by the AAFP in the most recent issue of Family Practice Management... can also access in the FPM "toolbox" under the Medicare section... have to be AAFP member to view these tools, though.
One could convert this into a template for AC, or just import the form annually.

Thanks Santos! I really appreciate your post. I am going to start scheduling my Seniors for their annual wellness visit.

The American College of Physician Executives is an organization for physician leaders at all levels from small business owners (your clinic) to medical directors, chief medical officers, and anything in between. Their journal is a neat read, but their daily brief is amazing. http://www.acpe.org/ for more information

If you do an EM cpt code and the Annual Wellness Visit cpt on the same day, put a 25 modifier on the EM.
The ICD9 codes for the AWV should be whatever pertains to that PT in their PPPS (401.1 for HTN/272.4 for Hyperlipedemia etc.)

I think we should have some new forum categories: for instance one on just coding. This forum is so helpful in so many ways.

I came across two ACP websites, I thought to share it with the forum. They are related to the new medicare wellness exam and the 2011 medicare E prescribing incentive program. They are very useful.

http://www.acponline.org/running_practice/practice_management/payment_coding/wellness.htm

http://www.acponline.org/running_practice/technology/eprescribing/medicare_program_overview.pdf

Sample Annual Wellness Visit Exam Form Template:

http://mybraintest.org/dl/Sample_Medicare_Annual_Wellness_Visit_Exam_Form.pdf

Sample Personalized Prevention Plan (PPPS) Template:

http://mybraintest.org/dl/Sample_Personalized_Health_Plan_for_Annual_Wellness_Visit.pdf

Suggestions on how to improve the templates are welcome.

Christian Elliott
MyBrainTest.org
www.mybraintest.org

Are there any specific form that we have to use for the Introductory to Medicare Examination? When I was working back in Iowa for a large group, we had a specific form that was used and the internally auditing would be on us if this was completed to a 'T'. I cannot find any form on Medicare's website or any other website that is uniform. I know we are do the vision screen and the vitals, BMI, and +/- EKG as well as counseling on diet, exercise, Advance Directives, safety in the home, depression, etc. I just do not see where Medicare has a universal form for the Introductory to Medicare Exam and if any such form is required. I see where other users have templates which is what I'll be doing I guess too. If anyone knows of a universal form -- please let me know.

It.s v70.0

John,
This would be a good place to start:
www.aafp.org/fpm/2011/0100/fpm20110100p22-rt3.pdf
Dave

I did my first one of these today. The form from AAFP was very helpful. I did see this Medicare Learning Matters alert which makes it look like you can NOT bill a separate E&M visit on same day and get paid separately, even if you use the -25 modifier. I am going to play it safe and have them comeback on a separate day for the Annual Wellness visit (AWV).

MLN Matters

Information for Medicare Fee-for-Service Health Care Professionals



MLN Matters Number: MM7079 Revised
Related Change Request (CR) #: 7079

Related CR Release Date: February 15, 2011
Effective Date: January 1, 2011

Related CR Transmittal #: R138BP and R2159CP
Implementation Date: April 4, 2011



Annual Wellness Visit (AWV), Including Personalized Prevention Plan Services (PPPS)



Note: This article was revised on February 17, 2011, to reflect changes made to CR 7079. The changes made were the deletion of voluntary advance care planning as a specified element of the AWV, clarification that payment methodology for Types of Bill (TOB) 12X and 13X is based on the Medicare Physician Fee Schedule, and that for TOBs 71X and 77X, the AWV does not qualify for separate payment with another encounter. The CR transmittal numbers, CR release date, and the Web addresses for accessing CR 7079 have also changed. All other information remains the same.

I have developed an electronic "fillable" template for the AWV and will share it with anyone that is interested. It allows for the complete peformance of the AWV with asavable pdf that can be atached to an EMR.

I also have a computerized, expertly scored, cognitive 8-10 minute cognitive test avaialable that is far more accurate (96%) and easier to administer than an MMSE or other paper test.

Jeff
Florida

Jeff,

I see you have recently registered and this is your first post. Is this something you are selling? If so, this would not be the appropriate place for commercial offerings.

Well, he said "share" so I don't think he's selling it. Sounds more like "tell me if you're interested and I'll email it to you."

I did notice the "share" word but.... We'll see.

We have started to send home the pt questionnaire part of the exam with the pt ahead of time. This has been a real time saver.

Ditto! Agree! Coding issues are an ongoing headache and having fellow AC users help out would be tremendous. This will get to be even more of an issue as AC ventures into practice management.

We have updated the AWV Forms:
http://mybraintest.org/dl/Sample_Medicare_Annual_Wellness_Visit_Exam_Form.pdf

http://mybraintest.org/dl/Sample_Personalized_Health_Plan_for_Annual_Wellness_Visit.pdf

We're interested in working with AC users to standardize the field names and attributes on the forms, so that the field values/data can be added to the patient encounter record.

Thanks, Christian
www.mybraintest.org

I appreciate the forms and I've added some key points to the AC templates for making these visits a little more efficient. I've actually been doing a fair number of these Wellness Visits.

We have added a Health Risk Assessment form (pdf) that can be filled out by patients or informants:

http://mybraintest.org/dl/Health-Risk-Assessment-Form-MyBrainTest.pdf

Includes ADLs/IADLs for Medicare Annual Wellness Visit requirement.

Suggestions to improve on this form are welcome.

Christian Elliott
www.MyBrainTest.org