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Nancy Posted Mon 21st of February, 2011 20:00:14 PM

OMG, I know everyone is probably getting tired of all the questions about the new Annual Wellness Visits, but I have one more. I thought I had this straightened out but now I have a provider that has confused me. So here goes; if you have an established patient and they are past their IPPE, let's say about 1 yr, do you bill the initial AWV (G0438) or do you bill the subsequent (G0439) I say the initial because this is the first one the patient has had and then any after that would be the subsequent. Please let me know you thoughts and also does anyone have a form they are using for these visits? As always Thanks for your help.

SuperCoder Answered Mon 21st of February, 2011 20:32:59 PM

The Annual Wellness Visit (AWV) is not to be confused with the Welcome to Medicare Visit, also called the Initial Preventive Physical Examination (IPPE), though there are similarities.

Only one IPPE may be performed per beneficiary, and an IPPE may be performed only within the first 12-months of the beneficiary’s enrollment in Medicare Part B. No AWV is covered until 12 months after the IPPE, or until 12 months after the date of enrollment, if no IPPE is performed.

There are two types of AWVs - the first annual wellness visit (G0438) and subsequent annual wellness visits (G0439). G0438 may not be billed if the patient received an IPPE.

Dawnelle Answered Wed 23rd of February, 2011 20:35:18 PM

my understanding is if their 12 month IPPE period is expired then you should bill the AWV-initial.

Karen Answered Mon 14th of March, 2011 19:03:26 PM

There is some confusion at our office in regards to coding G0438 or G0439. And maybe someone can clear this up for us. If a patient comes in for an AWV (for an example they have had an IPPE, and they have been on MCR part B for 4 years), it is their first AWV since the change 1/1/2011 do we code the visit G0438 (since we have never coded the G0438 in the past)? Or would we could it G0439 because they have had annual check ups in the past?

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