Medicare Annual Wellness
Exam
Presented by:
Susan Duden, CPC.
March 24, 2012
Medicare Preventative Services
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Welcome to Medicare exam and physical
Vaccines
Various Screening procedures
Annual Wellness exam
Welcome to Medicare physical
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Must be performed within 12 months of the
patient’s effective date of Medicare part B
Once in a lifetime procedure
Screening EKG is only allowed if referral
from the IPPE appointment
G0402
Vaccines
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Flu Vaccine, one per flu season
Pneumococcal, 1 per lifetime, unless at risk
patient
HBV, limited to high risk patients
Various screening Procedures
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Prostate blood screening, 1 per year
Mammography, 1 per year
GYN, every 24 months unless at high risk
Colonoscopy, 1 per ten years
Bone Mass Measurements, 1 per 24 months
Etc.
Annual Wellness Exam
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Allowed 1 per year
Cannot be done within a year of the Welcome
to Medicare Physical
12 months apart
G0438, first visit for wellness exam
G0439, subsequent visits, every 12 months
Who can perform this exam?
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Doctor of Medicine or Doctor of Osteopathy
Nurse practitioner
Physician Assistant
Clinical Nurse Specialist
Health Professional
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Health educator, registered dietitian, nutrition
professional or a team of medical professionals
working under the direct supervision of a
Physician
What is included in the Annual
Wellness Exam?
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This is not a hands on physical!
Patient History
Benign examination
Counseling
Establishing the Medical/Family
History
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Collect and document the following:
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Past medical and surgical history
Allergies
Use or exposure to medications and supplements
Family history for disease or illness that may be
hereditary or place beneficiary at increased risk.
A list of providers and suppliers the patient is
currently using
Review of patient’s Risk Factors
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Screening for depression
Screen for risk of falls
Questions on home safety
Questions on hearing impairments
Cognitive abilities
The abilities to perform activities for daily
living
Benign Examination
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Height
Weight
Body Mass Index (BMI)
Blood pressure
Establishing a Written Screening
Schedule
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Make a check list for the next ten years
Based on the patient health status and history
Include age appropriate preventative services
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Up to and including bone mass measurements,
prostate cancer screening, colonoscopy,
mammography, seasonal flu vaccine and
pneumococcal vaccine, and, if the patient meets
the Medicare guidelines, a hepatitis B vaccine.
Establish a List of Risk Factors
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Risk factors or conditions where intervention
might be necessary
A list of treatment options and their
associated risks and benefits
Furnishing advise to patient on
preventative counseling
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Personalized health advice with referrals as
appropriate
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Including weight loss, physical activity, smoking
cessation, fall prevention nutrition and alcohol
abuse
Subsequent Annual Wellness Exams
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Frequency is 1 per year
Updating any of the provider or supplier
information, family history, etc
Assessing cognitive impairment
Weight, BMI, Blood pressure
Continued Counseling
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Update the written screening schedule
developed at the initial wellness exam
Update any risk factors that may have been
identified
Personalized referrals as appropriate.
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Including lifestyle interventions, weight loss,
physical activity, smoking or alcohol cessation,
fall prevention and nutrition.
Frequently asked questions
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Is the AWV the same as a yearly physical?
Are clinical laboratory tests part of the AWE?
Is there a deductible or coinsurance due for
the AWE?
Can a separate E&M be done on the same
day?
What the Patient should bring to the
Annual Wellness Exam
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A full list of current providers and suppliers
involved in providing care
Family Health history with as much detail as
possible
Medical records, including immunization records
A full list of medications
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Including supplements such as calcium and vitamins
How often and how much are they taking
Questions?
CMS links for Preventative
Information
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http://www.cms.gov/PrevntionGenInfo/
https://www.cms.gov/MLNProducts/downloa
ds/MPS_QRI_IPPE001a.pdf
https://www.cms.gov/MLNProducts/35_Preve
ntiveServices.asp
https://www.cms.gov/MLNProducts/downloa
ds/AWV_Chart_ICN905706.pdf