Annual Wellness Visits
Coding an AWV can seem complicated, but it is actually very simple. Here are some coding tips:
- G-codes specify what kind of a visit it is:
- G0402 is a once-in-a-lifetime benefit and completed within the first year of a patient’s Medicare eligibility.
- G0438 is assigned as the initial visit. Patients are eligible after the first 12 months.
- G0439 is assigned after that first year and assigned annually.
- AWVs offer a great chance to drop HCC codes, but you must address each chronic disease if you drop these.
- You may add a comprehensive physical exam for Medicare Advantage patients, but not for Medicare patients:
- 99387 for new patients.
- 99397 for established patients.
- You can also add additional codes if you do the counseling (these are a few of the most popular ones):
- Depression screening: 96127 or G0444.
- Advance care planning: 99497.
- Smoking cessation counseling: 99406, 99407.
- Obesity counseling: G0447.
- Pelvic exam: G0101.
- Alcohol misuse counseling: G0442.
- More details about all the screening services covered can be found here.
- You can add an E/M code with a modifier, but only if you are addressing a new complaint outside the wellness visit or an abnormal finding on review of a test or exam. If you do this, we recommend using transitional statements such as, “This completes the wellness portion of the visit, patient now presents for…”
- And finally, don’t forget to add modifier 33 to these so that the co-pay is waived.
More information about AWVs and how they are coded can be found here: Annual Wellness Visits and Annual Wellness Visit coding.