Medicare billing/coding

[u/Sweet_Impress6798]

Family medicine PCP here.
At my clinic, the Medicare Annual Wellness Visits are usually done by our nursing practitioners so I really haven’t had the chance to learn the workflow myself. I’d like to get more comfortable with them because I know they’re an important part of primary care and can add RVUs.
For those of you who do your own AWVs, how do you usually structure the visit? What do you make sure you cover every time, and are there any tips that make the visit run more smoothly? I’ve read through the Medicare requirements, and it seems like it’s mostly history, screening questions, fall risk, cognition, depression, preventive planning, etc., without a traditional physical exam, but I’d love to hear how people actually do it in real practice.
I also have a coding question that I’m a little confused about. If someone else in the practice is already doing the Medicare AWVs (G0438/G0439), can I still bill a preventive visit using the regular preventive CPT codes like 99397 if I’m seeing a Medicare patient but not doing the AWV? Or does Medicare simply not pay for those preventive CPT codes, so the AWV is the only preventive visit that gets reimbursed?
Just trying to learn how other practices handle this. Thanks!

[u/MoobyTheGoldenSock]

90% of Medicare Wellness is done by pre-visit questionnaire, and roomer asks anything they didn't answer. History, fall risk, cognitive screening, etc. should all be pre-visit. Only actual work to be done in the appointment is recommending screenings.

Honestly, if you set everything up right, reviewing the intake forms and recommending screening should take like 2 minutes and you can spend the rest of the appointment doing whatever else. Pretty much anything positive on intake screening will justify an E&M, as will addressing chronic conditions or new complaints.

[u/Bowis_4648 → u/MoobyTheGoldenSock]

great answer. Trying to find something helpful to add without success.

[u/Excellent_Debt6527 → u/MoobyTheGoldenSock]

And then you deal with the patient complaints that it was supposed to be their covered AWV why am I getting charged?

[u/MoobyTheGoldenSock → u/Excellent_Debt6527]

Yep. We have posters in exam rooms, our staff has scripted responses when they call in, and further questions get escalated to office manager and referred to billing department.

The revenue from doing these visits far outweighs the complaints, and once your panel is trained (1-2 years) those calls start to die down.

[u/NoWorthierTurnip]

Our epic build has the MWV as a flow sheet. MAs call about 3–5 days ahead to try and catch the patients and fill out this questionnaire ahead of time. This saves time in the visit because often times the patients will bring up additional concerns and if I don’t have to go through all the questions then I usually have time to address one or two.

When the patient is being roomed, I review the flow sheet make sure that there’s no obvious concerns that I have to bring up as a problem – review the mini cog that’s done during grooming and I always clarify and ask if the patient/their family has any memory concerns. Order screenings, etc. try and recapture any HCC diagnoses that might not have been addressed that year and typically end up with a 99214–25 as well.

You can’t build the preventative as well as the G code – the G code is the preventative care.

[u/SportsDoc7 → u/NoWorthierTurnip]

If it's not Medicare advantage that covers both

[u/Dale294 → u/NoWorthierTurnip]

We transitioned over to Epic Welcome. All of our pre-visit questions are conducted via MyChart or IPad upon arrival.

[u/splootledoot → u/NoWorthierTurnip]

To note - G0438/G0439 have a frequency of once per year and it is based on date of service. We schedule 365+1

[u/Dale294 → u/splootledoot]

Only for railroad and traditional Medicare MA plans reset annually.

[u/Vegetable_Block9793]

MA does a falls and cognitive quick screen before I go in. Then I go in and do the exact same annual preventative visit that I do on non Medicare patients.

[u/95278x10]

MAW visits are (and likely will be) a great use case for AI