American College of Physicians: Internal Medicine — Doctors for Adults ®

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Coding made easy for annual wellness visits

From the June ACP Internist, copyright 2011 by the American College of Physicians

Finally! Physicians can now get paid for personalized prevention planning that they previously were not providing—or were giving away—to Medicare patients.

As part of the Affordable Care Act, Medicare will now pay for an annual wellness visit, a yearly exam that focuses on establishing and, through subsequent annual wellness visits, maintaining a personalized prevention plan. The annual wellness visit is not the same as the “Welcome to Medicare” exam (which happens only in the first year as a Medicare beneficiary) or the “traditional” annual physical (it does not include any diagnostic testing or physical exams). Medicare exams and their codes are described in this table.

There has been some confusion as to whether physicians can bill for an evaluation and management visit using the 25 modifier. The answer is yes, but documentation for the evaluation and management service must meet the evaluation and management requirements. Medicare originally expected that it would be “uncommon” to need the modifier, but has clarified that its use will be relatively common. It is always prudent to check with your Medicare carrier periodically in case guidelines change.

The annual wellness visit is a new benefit that includes certain specific services, and it will take some practice to master the coding and patient education. To help integrate the annual wellness visit into daily practice, ACP has developed some simple materials for patients, including a letter explaining the new benefit, a checklist of what to bring to the appointment, and a take-home plan for easy reference. There is also a checklist for the practice staff to use as well as a “how to bill it” guide.

These materials can be found at ACP’s Annual Wellness Visit section. For more information on preventive services in general, visit ACP’s Medicare coding section.

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