Find information on Medicare Wellness Visits, including Initial Preventive Physical Examination (IPPE), Annual Wellness Visits (AWV), G0402, G0438, G0439 billing codes, Healthcare Effectiveness Data and Information Set (HEDIS) measures, clinical documentation requirements, risk assessment, and preventive services. Learn about accurate medical coding and diagnosis reporting for optimal reimbursement. This resource provides guidance for healthcare professionals on conducting and documenting these important preventive exams.
Also known as
Factors influencing health status
Covers encounters for circumstances other than disease or injury.
Encounter for general exam w/o complaint
Specifically for routine general medical examinations without a reported complaint.
Person encountering health services
Encounters for counseling and surveillance of previously diagnosed conditions.
Follow this step-by-step guide to choose the correct ICD-10 code.
Is this an Initial Preventive Physical Examination (IPPE)?
Yes
Code G0402: Initial preventive physical examination; face-to-face visit, services limited to new patient in Medicare Part B
No
Is this a subsequent Annual Wellness Visit?
When to use each related code
| Description |
|---|
| Welcome to Medicare visit |
| Annual wellness visit |
| Subsequent hospital care |
Coding G0439 for established patients or non-IPPE visits leads to denials. Ensure proper patient history for accurate code selection.
Lack of documented ACP or discussions during AWV can trigger audits. Comprehensive documentation is crucial for compliance.
Billing individual components already included in G0438/9 is non-compliant. Ensure correct bundled code usage for reimbursement.
Patient presents for an Annual Wellness Visit (AWV), also known as an Initial Preventive Physical Examination (IPPE) or subsequent Medicare Wellness Visit. This Medicare preventative service focuses on health risk assessment and personalized prevention plan development. The patient's medical history, family history, and current medications were reviewed. Vital signs including blood pressure, heart rate, respiratory rate, and temperature were recorded and within normal limits. A comprehensive review of systems was conducted, addressing cardiovascular health, respiratory function, gastrointestinal issues, neurological symptoms, musculoskeletal concerns, and mental health status. The patient's functional ability and fall risk were assessed. Screening recommendations per the United States Preventive Services Task Force (USPSTF) guidelines, including cancer screenings, immunizations, and other preventive services, were discussed. A personalized prevention plan was developed, addressing lifestyle modifications such as diet, exercise, and smoking cessation, as well as chronic disease management strategies. Patient education regarding healthy aging, fall prevention, and advance care planning was provided. Appropriate referrals and follow-up appointments were scheduled. This visit fulfills the requirements for the Medicare Annual Wellness Visit, focusing on preventive care and health promotion. Billing codes G0438 (for the initial AWV) or G0439 (for subsequent AWVs) are applicable, depending on the patient's history of AWVs.