Posted by Mary Pat Whaley on July 21, 2011
Today’s CMS call reviewed the guidelines for the IPPE (Initial Preventive Physical Exam) and the AWV (Annual Wellness Visit), what they include and how to code for them.
What is the IPPE (also called the “Welcome to Medicare Visit”)?
The IPPE is a one-time visit, covered within 12 months after the effective date of Part B coverage and including:
- Review of medical and social history.
- Review of risk factors for depression.
- Review of functional ability and level of safety.
- Measurement of height, weight, body mass index, blood pressure, visual acuity, and other factors deemed appropriate.
- Discussion of end-of-life planning, if agreed upon by the patient.
- Education, counseling and referrals based on results of review and evaluation services performed during the visit, including a brief written plan such as a checklist, and if appropriate, education, counseling and referral for obtaining an electrocardiogram (a/k/a EKG, ECG).
- Note that although the IPPE has the word “exam” in it, there is NO physical exam associated with it. Most practices attempt to call it the Welcome to Medicare Visit and try never to use the word “exam” in association with it.
Who can provide the IPPE?
- Physician (doctor of medicine or osteopathy)
- Qualified non-physician practitioner including nurse practitioner physician assistant or Clinical nurse specialist
How is the IPPE Billed?
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Tags: 99381 to 99397, AAA ultrasound, ACA, Affordable Care Act, APC, Article 28 Institution, AWV, CAH, CMS, collecting for the Medicare EKG, cost-sharing, depression screening, does Medicare pay for physicals?, E & M, ECG, EKG, evaluation and management, G0389, G0402, G0403, G0404, G0405, G0438, G0439, ICD-9, IPPE, Medicare annual physical, Medicare free physical, Medicare Part B, Medicare preventive care, mental acuity screening, modifier 25, Proposed Rule for Refinement of AWV, provider-based billing, RHC, UB92, Welcome to Medicare, who can do a AWV?, who can do an IPPE?
Posted in: Collections, Billing & Coding, Compliance, Day-to-Day Operations, Medicare & Reimbursement
In 2011, the Centers for Medicare and Medicaid (CMS) unveiled a new benefit to address the need for annual care for seniors. It was widely hailed as a wonderful thing for Medicare patients who previously had no preventive care unless they paid out-of-pocket for a “complete physical.” What some people overlook is that the new Medicare benefit includes no actual physical examination of any kind.