Awareness : OBC Tips

Opioid Use during the Initial Preventive Physical Examination (IPPE) and Annual Wellness Visit (AWV)

On August 28, 2018, Medicare Learning Network (MLN) released an article emphasizing the existing policy for eligible health care providers who furnish the AWV to Medicare patients.

The Medicare Wellness Visit provides an opportunity for providers to have conversations on important topics.  One of the topics that should be touched on is the use of opioids. The review of opioid use is an important component of the patient’s medical history and is key in diagnosing and treating opioid use disorders (OUD). 

The AWV is covered by Medicare on an annual basis for patients who are no longer within 12 months of the effective date of their first Part B coverage period and have not received either an IPPE or AWV within the previous 12 months. The elements in first and subsequent AWVs, and the codes to bill them are different.

The first AWV includes the following elements:

  • A health risk assessment
  • Establishment of a current list of provider and suppliers
  • Review of medical and family history (Medicare would like to emphasize that review of opioid use is a routine component of this element, including OUD. If a patient is using opioids, assess the benefit from other, non-opioid pain therapies instead, even if the patient does not have OUD but is possibly at risk.)
  • Measurement of height, weight, BMI, and blood pressure
  • Review of potential risk factors for depression and other mood disorders
  • Review of functional ability and level of safety
  • Detection of any cognitive impairment the patient may have
  • Establishment of a written screening schedule (such as a checklist)
  • Establishment of a list of risk factors
  • Provision of personalized health advice and referral to appropriate health education or other preventive services.

Subsequent AWVs include the following elements:

  • Review of updated health risk assessment;
  • Update medical and family history (As mentioned above, Medicare would like to include opioid use in the ‘Review of Medical and Family History’ element of the AWV. Providers are encouraged to pay close attention to opioid use during this element of the AWV. If a patient is using opioids, assess the benefit from other, non-opioid pain therapies instead, even if the patient does not have OUD but is possibly at risk.)
  • Update of list of current providers and suppliers;
  • Measurement of weight and blood pressure;
  • Detection of cognitive impairment the patient may have;
  • Update of the written screening schedule (such as a checklist);
  • Update of the list of risk factors; and
  • Provision of personalized health advice and referral to appropriate health education or other preventive services.

Additional information is available in MLN Matters® article SE18004

source: https://www.cms.gov/Outreach-and-Education/Medicare-Learning-Network-MLN/MLNMattersArticles/Downloads/se18004.pdf