Providers: Reminder about Annual Wellness Visits documentation

Many providers want to bill for an Evaluation and Management (E&M) service (99212-99215) on the same date that a patient has his or her Annual Wellness Visit (AWV) (G0438 & G0439) to save the patient an extra visit. However, according to NGS, the Medicare carrier, in order to bill the E&M service on the same date, the visit must be medically necessary. What does that mean?

  • The visit must have complete documentation on its own, including a plan of care for the medical issues.
  • The patient may not have numerous recent visits for chronic problems.
  • Problems should be listed in the chief complaint or other history area and describe the patient’s current conditions.
  • There should be an addition to or change in the plan of care.

The Office of Privacy and Corporate Compliance (OPCC) recently audited the top providers for services billed in this fashion and has established certain educational requirements for providers who did not score well.