Optimizing Office Visits for Preventive Services #4: Other Services You Can Bill With a Wellness Visit

Kathy McCoy, MBA May 17th, 2012

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There are  other services you can provide and bill for the same day as a wellness visit, and expert Betsy Nicoletti explains how to do it.

In a difficult reimbursement environment such as this one, it’s critical to get paid for all the billable services that you and your clinicians provide. Preventive services are one area that received short shrift in the past, but Medicare and commercial payers have just recently become more willing to pay for them. How can you ensure your medical billing capitalizes on this welcome trend?

That was the subject of a recent webinar sponsored by Kareo called Optimizing Office Visits for Preventive Services. Conducted by respected coding expert and author Betsy Nicoletti, M.S., CPC, the webinar offered valuable pointers on what services are considered preventive, the Welcome to Medicare visit and the Annual Wellness Visit now being funded by Medicare.  Those were covered in our first three blogs on the webinar. Are there other services you can provide and bill for the same day as a wellness visit? Yes, and our final blog here will focus on those you can get paid for in conjunction with wellness visits.

Pelvic/breast exams (code G0101) are reimbursable when performed during a preventive services visit. Medicare pays for a pelvic/breast exam every year for high-risk patients, and every two years for low-risk patients. The exam must include inspection and palpation of the breast as one of 7 of 11 required elements of this type of exam. You can also bill for obtaining a screening pap smear by using code Q0091.

You can also bill for a problem-oriented office visit, but none of the documentation you have collected during the wellness visit can be used to determine the level of the services you have provided during the problem-oriented visit. And smoking cessation (G0436, G0437) is billable, but be sure the time you have spent is documented in the medical record and is in addition to (not part of) the other service.

You can also bill for a problem-oriented office visit, but none of the documentation you have collected during the wellness visit can be used to determine the level of the services you have provided during the problem-oriented visit.

In all cases, Betsy cautions coders and clinicians to be sure to include diagnosis codes. Failing to include them will trigger a denial. Be sure to link the diagnosis to the service for which you are billing.

While Medicare is now paying for some behavioral health services, the reimbursement is minimal. But clinicians can provide alcohol misuse screening and counseling, as well as screen for depression, and receive some reimbursement for it. These services must be provided in a primary care setting. Obesity counseling is also allowed weekly for one month, biweekly for months two through six and monthly if the patient has lost 3 kg in weeks seven through twelve.

Unfortunately, vaccinations are only covered as part of a Medicare patient’s pharmacy benefit—not under Medicare Part B—and are therefore not a source of revenue for clinicians administering them.

If you are on the fence when it comes to deciding if you want to provide preventive services, remember that CMS believes it will help keep patients healthy and Medicare patients will expect to take advantage of them. They can be a source of revenue for your practice if you know the requirements for each type of service and schedule the right type of visit up front. It’s costly when a patient believes they are in the office for a wellness visit and your staff has opened the template for a problem-oriented visit. Be sure to develop or use forms from specialty societies that meet the requirements. Remember, if you have the correct process in place, you can provide a valuable service to your patients and get paid for doing it.

Kareo regularly sponsors informative webinars such as this one on a variety of timely topics. From maximizing cash flow to managing the transition to ICD-10, you can take advantage of our valuable knowledgebase free of charge.  If you would like to find information on any other topics of interest, feel free to check our webinar archive. Register now for our next educational webinar, Using RVUs to Improve Your Bottom Line, and learn how to maximize your revenue using this valuable tool.

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