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Coding Medicare Annual vs. Regular Physicals (Part 1)
JoAnne: Q: [Medicare Physicals] I would like to know more about coding a Medicare annual & subsequent visit comparing to a regular physical which we all know Medicare does not cover. They cover 1 welcome to Medicare physical & then start with the annual or subsequent visits.
A: This is probably the most confusing set of coding that I have found physicians to experience. For some reason when Medicare developed these procedure codes, they just assumed that this was going to be a comprehensive physical checkup. And it’s not at all; it’s mostly record keeping and making list of the patient’s history and whatever. When you bill for these codes, we have a number of them. One of them is the Welcome to Medicare, which you would begin with the time you turn 65 and you have the year to see the doctor and they would bill a Welcome to Medicare, and you don’t need a V70.0 as an annual physical exam, it is not necessary, any diagnosis will do. Like I said, it’s only from when you’re Medicare eligible for the first 12 months.
Then, when you have the year is passed, you go to what’s called an Annual Wellness Visit and that’s G0438, that’s an Initial Annual Wellness Visit. What I would recommend to people that do any billing and coding, go on to the Medicare website, and get the status of where your patients are at because a lot of doctors will bill for the Welcome to Medicare when a year has already passed or the patient may have already seen another doctor, and so, you would have to jump to the next level of the G0438. It’s 12 months after the Welcome to Medicare Visit and it is not physical exam. The 99387 and 99397 are completely different and they’re not paid for by Medicare. These are definitely wellness visits where they record a lot of the patient history and they’re monitoring their health and focusing on preventive care.
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