Don’t Bill Annual Wellness Visit As ‘Incident To,’ CMS Says
Posted on 01. Apr, 2012 by dchandhok in Provider News
Whether you consider yourself a pro in Medicare preventive service or are just working up on your Welcome to Medicare and Annual Wellness Visit (AWV) coding, you can always use some tips to better your work. Here’s some help from CMS direction on accurately reporting these services.
Check out the following answers to your most frequently-asked Medicare preventive visit questions, which were answered during CMS’s “Medicare Preventive Services National Provider Call” on March 28.
Avoid Incident-to for WTM, AWV Patients
Question 1: Can the “Welcome to Medicare” (WTM) exam or the annual wellness visit (AWV) be reported based on “incident-to” guidelines?
Answer: No. The WTM exam, also referred to as the Initial Preventive Physical Examination (IPPE), “is not subject to incident-to billing,” said Stephanie Frilling, health insurance specialist with CMS, during the call. “The payment policy for furnishing services incident-to a physician do not apply to the IPPE, as this service has its own benefit category,” she said.
“Likewise, the AWV is not subject to incident to rules,” Frilling said. If a non-physician provider such as a nurse practitioner performs either of these services, he must bill under his own NPI, the CMS reps added.
Question 2: Which diagnosis code should be reported with the WTM exam and the AWV?
Answer: CMS does not dictate which ICD-9 code should be linked to the WTM exam code (G0402, Initial preventive physical examination; face-to-face visit, services limited to new beneficiary during the first 12 months of Medicare enrollment). Instead, you should select the most applicable diagnosis code from your physician’s documentation.
“An example of diagnosis codes that could be included on the WTM claim are V70.0 (Routine general medical examination at a health care facility), V70.3 (Other general medical examination for administrative purposes), or V70.9 (Unspecified...
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