Coding for New and Established Patient Visits
Evaluation and Management (E/M) codes for office visits (99202-99215) are determined by either total time spent on the date of the encounter or the level of Medical Decision Making (MDM). For internal medicine, where complex histories are common, MDM is often the determining factor. Your documentation must robustly support the complexity of problems, data reviewed, and risk to justify your code selection and protect against audits.
Annual Wellness Visits (AWVs) vs. Physicals
A frequent source of denials is confusing Medicare's Annual Wellness Visit (AWV) with a traditional physical. Medicare AWVs (G0438 for the initial visit, G0439 for subsequent) focus on creating or updating a personalized prevention plan and do not include a hands-on exam. Commercial insurance physicals (99381-99397) do.
Billing a Problem Visit with a Wellness Visit: If you address a significant, separate medical problem during an AWV or physical, you can bill for both. Append modifier 25 to the problem-oriented E/M code to signify it was a distinct service.
