Primary Care Coding Alert

Question: Which CPT and ICD-9 code should I use for a Medicare patient's annual physical coverage? Texas Subscriber Answer: Medicare doesn't cover routine preventive medicine E/M services, but you should bill the patient for this service. Use the appropriate age-specific reventive medicine service code with a routine exam diagnosis.

Suppose a 65-year-old established Medicare patient presents for his annual exam. You should record 99397 (Periodic comprehensive preventive medicine  reevaluation and management of an individual ... established patient; 65 years and over) and V70.0 (Routine general medical examination at a healthcare facility) and bill the patient. Under the Medicare Modernization Act, Medicare will cover a one-time initial wellness physical exam within six months of the day an individual first enrolls in  Medicare Part B, beginning with those who enroll in 2005. But Medicare hasn't yet published the details of this benefit. For more information on upcoming preventive medicine service benefits, download Medicare's fact sheet, available at www.cms.hhs.gov/medicarereform/drugcard/.