Q: When I go over a patient’s HRA (Health Risk Assessment) form for their Annual Wellness visit, that seems to cover the same questions that are in the wellness visit description. So really, the HRA form review is the wellness visit correct? I don’t have to do things twice?
A: There is a lot of crossover or duplication between most HRA forms and the AWV requirements, but these really do represent different things. Glad you asked, because some providers do think that the HRA form that the patient fills out is the AWV. They do cover some of the same ground: the questions about falls depression, ADLs, and cognition, but they are not exactly the same thing. The requirement is that the MD assess those screening items, and more, and that the patient answers those questions. The former concerns how you—the provider—thinks the patient is doing after study, and the HRA is what the patient thinks.
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A coder type knows that the HRA wasn't introduced until a year or so after the initial AWV codes came out, it is clearly a 'separate' thing. But providers don't all realize that. We see notes all time that look like a 99214, but a 99214 and a G0439 is billed, and when asked 'where's the AWV'—they point at the HRA and say 'that's my AWV, the stuff's all there’.
The AWV itself needs to look more like an encounter with a human than a checklist. Medicare wants the MD to indicate how Bob or Betty is doing overall, the history and relevant screening aspects in their lives. Your detection of cognitive impairment is usually a mini cog of some sort, the depression Screen a PHQ2 or PHQ9. That’s the ‘evidence’ of your work.
We have enough over-templated notes as it is – make your work for the AWV visible and quantifiable.
Bill Dacey, MHA, MBA, CPC-I is principal in The Dacey Group, Inc., a consulting firm dedicated to coding, documentation and compliance concerns for physicians. Bill is an evaluation and management (E/M) coding expert and has been active in physician training for more than 25 years. He can be reached at [email protected]