E/M Coding Alert - 2012 Issue 12
Preventive Services: Don't Bill Annual Wellness Visit As 'Incident To,' CMS Says
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Article Overview
This article reviews CMS answers to common questions about Medicare preventive services, with emphasis on the Welcome to Medicare exam, the Annual Wellness Visit, and related reporting considerations. It is useful for coders, billers, and clinical staff who work with Medicare preventive benefits and want a high-level understanding of CMS guidance on billing structure, diagnosis coding, required elements, and visit sequencing. The discussion also touches on participation by different physician specialties, use of modifier 25 with separately reportable evaluation and management services, and the role of the health risk assessment.
Why This Topic Matters
Medicare preventive visit claims can be denied or underpaid when reporting rules are misunderstood. This article helps readers recognize the main CMS policy areas that affect how these services are documented and submitted.
Article Sections
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Avoid Incident-to for WTM, AWV Patients
CMS guidance on whether these preventive services can be reported under incident-to billing and how non-physician practitioner involvement is handled. The section also introduces related diagnosis coding questions.
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Don't Report G0439 for 'Results' Visit
CMS discussion of annual wellness visit timing, visit sequencing, physician specialty questions, and the role of the health risk assessment in the service.
What You Will Learn
- How CMS addresses billing structure for Medicare preventive visits
- What the article says about diagnosis code reporting for preventive exams
- How separately reportable evaluation and management services are discussed in relation to preventive visits
- How the annual wellness visit is distinguished from a follow-up results discussion
- What the article says about physician specialty, health risk assessments, and eligibility timing
Who Should Read This
- Medical coders
- Billing staff
- Compliance staff
- Physicians
- Nurse practitioners
- Practice managers
Codes Discussed
Code Ranges Discussed
Modifiers Discussed
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