How to Document and Code Medicare Preventive Services

 

Think of this as your field guide to the rules surrounding Medicare preventive services.

Fam Pract Manag. 2016 Jul-Aug;23(4):9-12.

Author disclosure: no relevant financial affiliations disclosed.

Preventive services are a great opportunity to provide high-quality patient care and increase practice revenue. However, like most services provided to Medicare beneficiaries, many preventive services have specific elements that must be captured in the documentation, and not all services are reimbursable when separately reported on the same date.

Previous articles in Family Practice Management have offered tips and tools for providing and documenting the initial preventive physical examination (IPPE, or “Welcome to Medicare” physical) and annual wellness visits (AWVs). (See the FPM topic collection.) This article will focus on Medicare preventive services that may be provided in conjunction with an IPPE or AWV or as stand-alone services by family physicians.

The IPPE, AWVs, and separately reportable preventive services

Any discussion of Medicare preventive services should start with the basic requirements for the IPPE, the initial AWV, and the subsequent AWV. (See “Elements of the IPPE and AWV.”) A review of what's included in each of these Medicare preventive visits can make it easier to identify services that can be separately reported. Here are two examples:

  • Advance care planning (CPT codes 99497-99498) is an element of the IPPE and not separately reportable; however, it is separately reportable with an AWV if you add modifier 33 to the advance care planning code. (See more information on modifier 33 in FPM's “Coding & Documentation” department.)

  • An electrocardiogram (G0403-G0405) may be separately reported in conjunction with the IPPE, but it is not covered as a preventive service with the AWV.

ELEMENTS OF THE IPPE AND AWV

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IPPE - G0402Initial AWV - G0438Subsequent AWV - G0439

Information gathering

  • Review the medical and social history with attention to modifiable risk factors:

    • Past medical/surgical history,

    • Current medications and supplements,

    • Family history,

    • History of alcohol, tobacco, and illicit drug use,

    • Diet,

    • Physical activity.

  • Review potential risk factors for depression or other mood disorders

  • Review functional ability and level of safety:

    • Hearing impairment,

    • Activities of daily living,

    • Fall risk,

    • Home safety.

  • Establish the medical/family history:

    • Past medical/surgical history,

    • Current medications and supplements,

    • Family history.

  • Review the patient's health risk assessment, which includes:

    • Demographic data,

    • Self-assessment of health status,

    • Psychosocial risks,

    • Behavioral risks,

    • Activities of daily living (dressing, bathing, walking, etc.),

    • Instrumental activities of daily living (shopping, housekeeping, etc.).

  • Review potential risk factors for depression.

  • Review functional ability and level of safety:

About the Author

Cindy Hughes is an independent coding consultant based in El Dorado, Kan., and a contributing editor to Family Practice Management.

Author disclosure: no relevant financial affiliations disclosed.

 

Copyright © 2016 by the American Academy of Family Physicians.
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