decisionhealth Newsletters, Answer Books - 2012 Issue 1 (January)
Preventive Medicine / Preventive medicine questions and answers
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Article Overview
This article is a question-and-answer discussion for coding and billing professionals about preventive medicine services. It explains general issues related to preventive E/M reporting, the distinction between new and established patient preventive visits, how preventive and problem-oriented services may be handled when both are present, and what documentation is expected when a Medicare Annual Wellness Visit is not accepted. The discussion references CPT preventive medicine coding, Medicare AWV policy, and related CMS guidance, making it relevant for medical coders, billers, and compliance staff working with outpatient preventive care.
Why This Topic Matters
Preventive medicine billing can change based on patient status, the presence of problem-oriented care, and documentation of beneficiary choice. Understanding the article helps practices reduce claim denials, support accurate reporting, and align preventive visit documentation with payer expectations.
Article Sections
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New versus established patient preventive medicine billing
Discusses how patient status affects preventive medicine reporting and summarizes the general applicability of new and established patient distinctions within E/M coding.
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Split well/sick visits
Covers preventive encounters that also include problem-directed components and describes the broad documentation considerations involved in reporting the separate service portions.
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Declining an Annual Wellness Visit
Addresses documentation and payer concerns when a beneficiary chooses not to receive a Medicare Annual Wellness Visit and instead requests a self-pay preventive exam.
What You Will Learn
- How preventive medicine services are discussed in a question-and-answer format
- What factors affect reporting of new versus established patient preventive visits
- How preventive and problem-directed services are distinguished at a high level
- Why documentation matters when a Medicare Annual Wellness Visit is declined
- Which organizations and policy sources are referenced in the discussion
Who Should Read This
- Medical coders
- Medical billers
- Compliance staff
- Physician practice managers
- Primary care office staff
Codes Discussed
Code Ranges Discussed
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