Outpatient Facility Coding Alert - 2016 Issue 16
Annual Wellness Visits: This MAC Reminds Practices to Use Caution Billing Separate E/M With AWV
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Article Overview
This article explains Medicare billing considerations when an annual wellness visit or initial preventive physical exam is performed on the same day as a separately identifiable evaluation and management service. It is aimed at coders, billers, physicians, and other billing staff who need to understand documentation, modifier reporting, and general Medicare payment concepts related to preventive visits.
Why This Topic Matters
Correct reporting of same-day preventive and problem-oriented services affects compliance, payment, and patient cost sharing. The article highlights why documentation must clearly support separate services and why practices need to distinguish preventive visit elements from the additional E/M service.
Article Sections
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Background on Medicare preventive visits
Introduces the Medicare preventive visit types discussed in the article and the general billing scenario that can create overlap with additional problem-oriented services.
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Use modifier 25 for separate E/M services
Summarizes the reminder from CMS-related guidance about reporting a separate evaluation and management service along with a preventive visit and documenting it appropriately.
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Cost sharing considerations
Addresses patient payment responsibility when an additional evaluation and management service is provided during a preventive visit.
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Two examples help guide you
Presents illustrative scenarios showing when a same-day additional evaluation and management service may be reported with a preventive visit.
What You Will Learn
- How Medicare preventive visits relate to separately identifiable evaluation and management services
- What general documentation considerations apply when reporting a same-day E/M service with a preventive visit
- What role modifier reporting plays in this billing scenario
- How patient cost sharing can differ between preventive and problem-oriented services
- How examples in the article illustrate the overall concept
Who Should Read This
- Medical coders
- Medical billers
- Physician practices
- Billing managers
- Compliance staff
- Clinicians documenting same-day services
Codes Discussed
Code Ranges Discussed
Modifiers Discussed
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