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wellness exam

Janice Posted Fri 07th of December, 2018 12:51:05 PM
can a cardiologist do a wellness exam the pt has a commercial plan and we have seen her before ??? what would that code be
SuperCoder Answered Mon 10th of December, 2018 08:25:16 AM

Hi, 

Our team is working on it and will get back soon.

 

SuperCoder Answered Tue 11th of December, 2018 07:29:03 AM

Hi, 

Wellness visits are performed by the following :

• Physician (doctor of medicine or osteopathic medicine)

• Physician assistant

• Nurse practitioner

• Clinical nurse specialist

• Medical professional 

However, if there is a finding or need for further investigation, then only the superspecialists come into action.

Further query is welcome.

Janice Posted Tue 11th of December, 2018 10:24:03 AM
A cardiologist is a Medical Professional (not sure what you mean) also they are a Physician or (are you meaning a PCP??) are you considering a cardiologist a super specialists???? what if any would the code be (or the range of codes) I told the cardiologist that it is usually the pt's PCP that does a wellness exam and she said any doctor could do one. Hence my question
SuperCoder Answered Wed 12th of December, 2018 02:54:04 AM

Hi Janice,

Happy to hear from you. There is a piece of information that I would like to share regarding the concerns.

According to Medicare, Medical professionals include a health educator, registered dietitian, nutrition professional, or other licensed practitioner), or a team of medical professionals directly supervised by a And physician includes doctor of medicine or osteopathy.

  • While Medical Doctors are – both Generalist and Specialist Practitioners, including Public Health Doctors.
  • Additionally, it is in sync that usually the patient’s PCP does a wellness exam. Furthermore, if any workup is required due to problems encountered in the wellness exam, then only the patients are referred to super specialists (Cardiologist is being considered a superspecialist).

In case of above mentioned patient, what was the service provided to the patient on first visit to the clinic?

Janice Posted Wed 12th of December, 2018 09:56:40 AM
i believe the pt didn't want to go to her pcp so she asked the cardiologist to do a wellness exam .I spoke with the doctor when she asked what the code would be- i told her that wellness is usually done by the pcp and she replied that any physician can do a wellness exam so i am trying to get some verbiage that i can show her.
SuperCoder Answered Thu 13th of December, 2018 04:44:14 AM

Hi,

In this case, CPT code range 99381-99387 will be appropriate. Kindly select the code accprding to age of the patient.

Janice Posted Thu 13th of December, 2018 14:06:25 PM
so you are saying that a cardiologist can do a wellness exam ????
SuperCoder Answered Mon 17th of December, 2018 08:59:12 AM

Hi,

Our team is working on it and will get back soon.

 

SuperCoder Answered Thu 20th of December, 2018 10:47:53 AM

Hi Janice, thank you for patience!

As per guidelines, Medicare does not cover a routine physical exam, an Annual Wellness Visit (AWV) contains elements that are similar to a check-up or physical. Eligibility for the Medicare beneficiary should be considered for the patients who has been receiving Medicare Part B benefits for at least 12 months and has not had an initial preventive physical examination or an AWV within the past 12 months.

As described earlier, AWV visits can be performed by Physician, Physician assistant, Nurse practitioner, Clinical nurse specialist, Medical professional. However, Medicare prefer patient to get the AWV done by PCP, if there is a finding or need for further investigation, then only the super specialists come into picture, i.e. cardiologist etc. As per Medicare, the AWV are usually planned visits, if your cardiologist is authorized and planned the AWV, then can bill for it. Since, your patient has the commercial plan, then you need to check the payer policies before billing.

Hope this helps!

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