I don't understand why the OP's doc did not code as a Welcome to Medicare exam.
But depending on what the doctor did, it might not qualify as a Welcome to Medicare exam.
Here is what is included in a Welcome to Medicare exam (which they actually call a "visit" in their description, which sounds more accurate to me because there's no actual physical exam):
This visit includes a review of your medical and social history related to your health. It also includes education and counseling about preventive services, including these:
- Certain screenings, flu and pneumococcal shots, and referrals for other care, if needed.
- Height, weight, and blood pressure measurements.
- A calculation of your body mass index.
- A simple vision test.
- A review of your potential risk for depression and your level of safety.
- An offer to talk with you about creating advance directives.
- A written plan letting you know which screenings, shots, and other preventive services you need.
Did the OP's wife receive all of these elements? If not, then it wasn't a Welcome to Medicare visit, and the problem isn't the coding; the problem is that the service provided doesn't meet the criteria for a Welcome to Medicare visit.
What's less clear (to me) is whether it's still a Welcome to Medicare visit if all of the criteria are met, but other services are provided, too (e.g., actually laying hands on the patient, which a Welcome to Medicare visit doesn't include). I suppose it could be accurately billed as a Welcome to Medicare visit, since it met all that criteria. But as for the time spent doing more than what is required for a Welcome to Medicare visit, do doctors generally do more than what is required by the billing code without the expectation of being compensated for that time? Are they even allowed to do that, or does that change the nature of the visit and therefore the billing code, turning it into something other than a Welcome to Medicare visit?
The problem is that Medicare specifically excludes routine physical exams from coverage, and a lot of people don't realize it and even those who do don't think it's right for routine physicals not to be covered. If a person gets a routine physical exam and Medicare doesn't pay for it, it's not a coding problem. The problem is that a routine physical isn't covered by Medicare, and changing the coding to match the desired result (coverage by Medicare) seems pretty sketchy.