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Practice Management Alert

New Codes Are Key to Billing 'Welcome to Medicare' Exam

Published on Mon Dec 20, 2004

New Medicare beneficiaries will now have better preventive-care coverage

Providers still aren't happy about the low reimbursement attached to Medicare's new preventive physical, but like it or not, you'll need to be ready to report this service come Jan. 1.

Medicare's final rule for physician payment for 2005 includes a new "Welcome to Medicare Physical" for all new beneficiaries. "This exam gives physicians the opportunity to make an overall assessment of a patient's health, and provide counseling on nutrition and other steps to stay healthy," according to CMS.
 
The introduction of this exam is a "step in the right direction" because Medicare is acknowledging the value of preventive-care services, says Mary I. Falbo, MBA, CPC, president of Millennium Healthcare Consulting Inc. in Lansdale, Pa.

Use New G Codes

Main code: You should bill for the physical exam with G0344 (Initial preventive physical examination; face-to-face visit, services limited to new beneficiary during the first six months of Medicare enrollment), Falbo says.

EKG: The "Welcome" physical includes an EKG, so you must also report the appropriate G code for that service, depending on what portion of the EKG your provider performs. Choose from: 
 

  • G0366 (Electrocardiogram, routine ECG with at least 12 leads; with interpretation and report, performed as a component of the initial preventive physical examination) for the global EKG
     
  • G0367 (...tracing only, without interpretation and report, performed as a component of the initial preventive physical examination) for the tracing
     
  • G0368 (...interpretation and report only, performed as a component of the initial preventive physical examination) for the interpretation and report only, Falbo says.

    Diagnosis: Because this exam is a preventive visit, you should link diagnosis code V70.0 (Routine general medical examination at a healthcare facility) to justify the service.

    Good news: Prior to publishing the final rule, Medicare had proposed limiting the level of E/M service providers could report on the same day as the "Welcome" physical. Providers would have only been able to report a level- two visit if the patient presented with a problem requiring treatment, Falbo says. But because so many providers complained this would be unfair, the final rule includes no limit on the level of service for an E/M during the same session as the "Welcome" physical.

    Payment: As of right now, Medicare will reimburse the "Welcome" physical at $124, Falbo says. But providers are still lobbying for increased reimbursement in the area of $250. A final reimbursement decision won't come out until February.

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