How do I code an annual wellness visit for a patient with pain and a chronic condition?

From the Guidelines

For an annual wellness visit where the patient has pain and a chronic condition, code as follows: use the appropriate annual wellness visit code (G0438 for initial, G0439 for subsequent), add the chronic care management code (99490) if you spend at least 20 minutes per month managing the chronic condition, include the relevant ICD-10 codes for the chronic condition and pain, and consider adding a problem-oriented E/M code with modifier -25 if addressing the pain or chronic condition requires significant additional work beyond the wellness visit. When coding for the patient's condition, it is essential to consider the patient's needs, preferences, and priorities regarding pain management, as well as their pain characteristics, including severity, type, spread, and quality, as recommended by the EULAR guidelines 1. The British Pain Society's pathway for care also emphasizes the importance of identifying psychosocial factors that may increase pain and associated disability, and using terminology that is consistent with current practices 1. Key steps to coding the visit include:

• Using the appropriate annual wellness visit code
• Adding the chronic care management code if applicable
• Including relevant ICD-10 codes for the chronic condition and pain
• Considering additional codes for problem-oriented E/M services if necessary It is crucial to document the time spent on chronic care management separately from the wellness visit and ensure that the documentation clearly supports the use of each code, as this approach allows for comprehensive coding that reflects the complexity of the visit while maintaining compliance with billing guidelines.

From the Research

Coding for Annual Wellness Visits

To code an annual wellness visit for a patient with pain and a chronic condition, consider the following:

• The Medicare Annual Wellness Visit is a preventive health benefit that provides an opportunity for clinicians to review preventive health recommendations and screen for geriatric syndromes 2
• The visit can be used to improve the care of geriatric patients and can be incorporated into a busy clinic 2
• For patients with chronic pain, chiropractic care can be an effective treatment option, and the frequency of visits can impact outcomes 3
• RN-led annual wellness visits can be beneficial in primary care practices, increasing patient access to care and facilitating discussions around overall mental and emotional well-being 4

Considerations for Coding

When coding for an annual wellness visit, consider the following:

• The patient's specific condition and needs, such as chronic pain or a chronic condition
• The services provided during the visit, such as preventive health recommendations and screenings
• The use of the 4Ms framework (what matters, medication, mentation, and mobility) in RN-led annual wellness visits 4
• The importance of ongoing support and follow-up between visits to enhance health outcomes 5

Relevant Studies

Studies have shown that:

• Annual wellness visits can be effective in improving health outcomes for patients with chronic conditions 6, 2
• Chiropractic care can be an effective treatment option for patients with chronic pain 3
• RN-led annual wellness visits can increase patient access to care and facilitate discussions around overall mental and emotional well-being 4
• Ongoing support and follow-up between visits can enhance health outcomes 5