Combining annual wellness visits (AWVs) with problem-based evaluation and management (E/M) services is a powerful strategy for your medical practice to enhance patient care and engagement, increase revenue, and improve quality metrics.

Redesigning visit workflows to accommodate this combination can be a high-yield strategy, according to a 9-month study published in the Annals of Family Medicine. The researchers found that annual wellness visit with E/M code combinations led to significant improvements in both patient care and practice efficiency:

Learn about the benefits of combined visits, and how to implement them at your practice.

Medicare allows physicians to report an AWV with a separately identifiable E/M service on the same day using modifier -25. Rather than convert scheduled AWVs to problem-based visits when patients raise new medical complaints, researchers found that it may be more effective to schedule a 40–50 minute combined visit from the outset.

While a clinician could see multiple standard-visit patients in that time, the combined visit boosts preventative care completion and makes AWVs more financially advantageous to offer. This approach also incentivizes clinicians to embrace AWVs by giving them the necessary time to care for the patient, which increases operational efficiency and helps manage patient expectation about the visit’s scope. 

If the patient doesn’t have any other problems to address, the physician simply bills for the AWV. 

Note: As your AWV volume increases, you can also leverage physician associates, such as nurse practitioners and physician assistants, to perform these visits.

To successfully combine AWVs with problem-based visits, consider the following steps:

Will you convert all AWVs to combined visits, or pre-screen patients to determine whether they want to address an active concern? One method is to have patients complete a health risk assessment (HRA) in advance via the phone or patient portal.

Pre-visit calls to complete the HRA may even improve throughput and patient satisfaction. The completed assessment can then flag front-desk staff to book a longer appointment in anticipation of billing an annual wellness visit with E/M code.

Add a dedicated scheduling code for combined visits with a 40–50 minute time slot (e.g., 25–30 minutes for the AWV, 15–20 minutes for the E/M component). This allows you to build customized EHR templates that combine AWV and E/M elements, auto-linking screenings, vitals, and assessments. A distinct visit type for an annual wellness visit with E/M code also makes it easier to segment data for dashboards, outcome tracking, and value-based contracts.

Train your team, especially front-desk staff, to explain how billing works for a combined visit. At the time of booking, they should obtain informed patient consent after explaining that the wellness portion is covered in full (no cost-sharing under Medicare), but the problem-based visit may generate a co-pay or deductible. 

Here’s a sample script for staff:

“Medicare covers your wellness visit completely. If you also discuss or get treatment for medical issues or symptoms today, Medicare treats that part as a separate office visit, which may have a co-payment or deductible depending on your plan.” 

Medical assistants and providers can reiterate this message during the visit to enhance transparency and build trust. Consider creating a flyer or patient portal message that explains the purpose of an AWV and why patients may receive a separate bill.

Emphasize that the practice is following Medicare rules that require separate documentation and coding when both preventive and diagnostic work occur — not double billing. Encourage patients to ask questions before the visit so they feel informed, not surprised.

Conduct regular audits to verify that the -25 modifier is justified and that notes show separate work for the problem-oriented service. Ensure correct diagnosis codes, including a Z code for the AWV and a problem-related ICD-10-CM code for the E/M service, keeping in mind that the problem should meet medical necessity criteria for E/M billing.

By strategically combining AWVs with problem-based visits, your practice optimizes billing and builds a more efficient, proactive, and patient-centric care model. Planning ahead for these comprehensive visits ensures that providers have the time they need to balance preventive and problem-based concerns. This allows patients to receive holistic care and the practice to thrive.

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