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Annual Wellness Visit & Health Risk Assessment

September 30th, 2017 - Find-A-Code
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G0438 (INITIAL) G0439 (SUBSEQUENT)


Annual Wellness Visits are not the same thing as other types of wellness visits. They are very specific requirements as outlined in the information that follows. Note that these codes are covered by Medicare.

Annual wellness visit;
G0438             includes a personalized prevention plan of service (PPS), initial visit
G0439             includes a personalized prevention plan of service (PPS), subsequent visit

Explanation

Annual Wellness Visits (AWV) must include a Personalized Prevention Plan of Service (PPPS) and a Health Risk Assessment .

Coding Tips

  • Physician (a doctor of medicine r osteopathy)
  • Qualified non-pnysician practitioner (a physician assistant, nurse practitioner, or certified clinical nurse specialist)
  • Medical professional (including a health educator, registered dietitian, nutrition professional, or other licensed practitioner)
  • Team of such medical professionals who are working under the direct supervision of a physician (doctor of medicine or osteopathy)

Diagnoses

“Since CMS does not require a specific diagnosis code for the AWV, you may choose any appropriate diagnosis code. You must report a diagnosis code.”

Modifiers


96160, 96161 HEALTH RISK ASSESSMENT


96160 Administration of patient-focused health risk assessment instrument (eg, health hazard appraisal) with scoring and documentation, per standardized instrument
96161 Administration of cargiver-focused health risk assessment instrument (eg, depression inventory) for the benefit of the patient, with scoring and documentation, per standardized instrument
Alert: These were new codes for 2017. They replaced deleted code 99420.

According to the PPACA, a Health Risk Assessment (HRA):

The patient’s health status and relevant conditions with risk adjusted HCCs (Hierarchical Condition Codes) assist CMS when tracking chronic conditions to help predict future healthcare needs, and is currently being used as a funding methodology. The idea is to risk adjust plan payments based on health status and demographic characteristics of an enrollee.

Coding Tips

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