Close this search box.

Risk Coding

Risk Coding – March 2023

Annual Wellness Visits​

Coding an AWV can seem complicated, but it is actually very simple. Here are some coding tips:​

  1. G-codes specify what kind of a visit it is:​
    1. G0402 is a once-in-a-lifetime benefit and completed within the first year of a patient’s Medicare eligibility.
    2. G0438 is assigned as the initial visit. Patients are eligible after the first 12 months. ​
    3. G0439 is assigned after that first year and assigned annually. ​
  2. AWVs offer a great chance to drop HCC codes, but you must address each chronic disease if you drop these.​
  3. You may add a comprehensive physical exam for Medicare Advantage patients, but not for Medicare patients:​
    1. 99387 for new patients.​
    2. 99397 for established patients. ​
  4. You can also add additional codes if you do the counseling (these are a few of the most popular ones): ​
    1. Depression screening: 96127 or G0444.​
    2. Advance care planning: 99497.​
    3. Smoking cessation counseling: 99406, 99407.​
    4. Obesity counseling: G0447.​
    5. Pelvic exam: G0101.​
    6. Alcohol misuse counseling: G0442.​
    7. More details about all the screening services covered can be found here.​
  5. You can add an E/M code with a modifier, but only if you are addressing a new complaint outside the wellness visit or an abnormal finding on review of a test or exam. If you do this, we recommend using transitional statements such as, “This completes the wellness portion of the visit, patient now presents for…” ​
  6. And finally, don’t forget to add modifier 33 to these so that the co-pay is waived.​

More information about AWVs and how they are coded can be found here: Annual Wellness Visits and​ Annual Wellness Visit coding.​

Provider Resources

New Education Module:
Value-based care for the care team