Preventive Visit – Initial Preventive – Annual Well Visit-Annual Well woman; Clearing the confusion.
Preventive Visit- Initial Preventive-Annual Well Visit-Annual Well woman; Clearing the confusion.
Preventive visit, Initial preventive visit, Annual well visit, and Annual well woman are words often used interchangeably by patients and healthcare professionals, yet they are not the same, actually very different. Below we will clear up that confusion.
MLN006559 – Medicare Preventive Services (cms.gov)
Preventive Visit | Initial Preventive Physical Exam (IPPE) | Annual Wellness Visit (AWV) | Annual Well Woman Visit | |
Codes | CPT codes: 99381-99387, 99394-99397 | HCPC Code: G0402 | HCPC Codes: G0438, G0439 | HCPC code: G0101 |
Definition | Exam performed without relationship to treatment or diagnosis for a specific illness, symptom, complaint, or injury | An IPPE is a review of a patient’s medical and social health history and includes education about other preventive services. | An AWV is a review of a patient’s personalized prevention plan of services and includes a health risk assessment. | Cervical or vaginal cancer screening; pelvic and clinical breast examination |
Coverage | Medicare Does not Cover | New Medicare patients within 12 months of starting Medicare | Covered once every 12 months | Annually for high risk. Semi-annually for low risk |
A Preventive visit (993XX) is a comprehensive assessment that goes beyond the Initial Preventive Physical Exam or Annual Wellness Visit. Alongside gathering family, social, and medical histories, it typically encompasses vital signs monitoring, lung, head and neck, abdominal, neurological, dermatological, and extremities examinations. It’s important to note that the Annual Wellness Visit isn’t intended to substitute or replicate the thoroughness of a preventive visit.
A Preventive visit (993xx) also includes the components of a Well Woman exam, for females. Both the 993xx and G0101 can never be billed on the same day by the same provider.
An IPPE comprises a health risk assessment, medical and social history, functional ability and safety, vital measurements, focused physical exam, end-of-life planning, create screening schedule, education and referrals.
An AWV comprises a health risk assessment, medical and social history, vial measurements, risk factors and health conditions, list of providers that care for the individual, screening schedule, education, and referrals.
An annual well woman is a breast to pelvis exam and must include seven of the following eleven elements: breasts, rectal, external genitalia, urethral meatus, urethra, bladder, vagina, cervix, uterus, adnexa/parametria, anus/perineum.
Ensuring that documentation aligns with the examination conducted is crucial. It may be beneficial to educate both patients and healthcare staff on using the correct terminology for various types of preventive visits. One suggestion is to create a chart displaying the differences between preventive services and make it visible to patients, facilitating their understanding.
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