Bill for additional services
Lab test done in the office
Administration of vaccines; vaccines if purchased
Venipuncture
Hearing and eye tests
Problem Oriented visit if documented
- Patient will be charged a co-pay/deductible
- Insurance coverage for second E/M Varies (use modifier 25)
- History documents symptoms/status
- A/P documents plan for problem visit

Annual Wellness Exam for Medicare patients!

G0402 – Welcome to Medicare Visit aka IPPE
The Initial Preventative Physical Exam (IPPE) also knows as “The Welcome to  Medicare Visit” is the covered wellness service during the first 12 months for a patient that has just qualified for Medicare B.  This is a once in a lifetime benefit that includes several exams that are normally not covered.

The Initial Preventative Physical Exam includes:
Medical, family social history, including medications, use of vitamins and supplement
Screen for depression (must use an accepted tool)
Screen for activities of daily living, safety, asking about hearing
Physical exam:  height, weight, BMI, BP, visual acuity
Screening EKG if needed
End of life planning (with patient consent)
Counseling , education and referral based on above
Written plan given to the patient for Medicare covered preventative services.

Also note that a Screening EKG at time of IPPE can be billed using G0403

G0438 – Annual Wellness Visit (AWV), Initial
Patients  who are eligible and have been enrolled in  Medicare for over 12 months and have “not” received an IPPE or an Annual Wellness Exam in 12 months.  This exam can only be performed once per patient (not per physician).  However, it is available to New or Established patients.

Initial Annual Wellness Visit includes:
Personalized prevention plan services
Health Risk Assessments (new for 2012)
-  CMS expects the patient to complete this before physician sees patient or will complete with staff
Taking/updating medical and family history
Establishing list of current providers and suppliers of medical care
Physical Exam:  height, weight, BMI calculation (or waist calculation), BP and other routine measurements as deemed appropriate
Detection of any cognitive impairments that the individual may have
By direct observation with consideration of information form medical records, patient reports, concerns raised by family members
Review potential for depression based on use of appropriate screening instrument
Review of individuals functional ability and level of safety based on direct observation or use of screen questionnaire regarding:  Hearing impairment, ability to successfully perform activities of daily living, fall risk and home safely.

Establish the following:
Written screening schedule such as a checklist for the next 5-10 years
List of risk factors and conditions for which primary, secondary or tertiary interventions are recommended
List of treatment options and their associated risks and benefits
Furnishing of personalized health advice and referral, as appropriate to health education or preventive counseling programs aimed at reducing identified risk and improving self management including weight loss, smoking cessation, fall prevention and nutrition

G0439 – Annual Wellness Visit (AVW), Subsequent
Update medical and family history
Update current providers
PE:  weight, BP and other routine measurements as deems appropriate (height and BMI not required)
Detections of cognitive function
Update the written screening schedule established at initial visit
Update the list of risk factors and conditions or which treatment was recommended
Furnish personalize health advice and referral, as appropriate to health education or preventive counseling programs aimed at reducing identified risk and improving self management including weight loss, smoking cessation, fall prevents and nutrition

Can you provide other covered services?
Yes, Bill for other covered preventive services, such as the pelvic and breast exam
- Important!  Remember frequency limits and diagnosis code requirements
Problem oriented office visit
Smoking cessation (G0436, G0437) require time is documented in the medical record and is in addition (not part of) the other service.

Breast and Pelvic Exam
G0101:  Be sure breast is one of the 7 Elements (out of 11) of the examination
Q0091:  Only used for obtaining a screening pap smear

E/M Services too?
Allowed for medically necessary, significant and separately identifiable service
Append modifier 25 to E/M service

Diagnoses Codes
IPPE and AWV, use V70.0
Pelvic and breast exam:
-  High Risk Annual use V15.89
-  Bi-Annual use V76.2, V76.47, V75.31
Colorectal Screening: V76.51 special screening for malignant neoplasms colon
Smoking cessation, use tobacco abuse 305.1
For problems, use the medical problem diagnosis