medicare PE

rthames052006

True Blue
Local Chapter Officer
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York, Pa
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Are you referring to the Annual Wellness Visit/ IPPE visits or are you just referring to the yearly physical visits 9939_, 9938_.
 

mshay134

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Re: Medicare physicals/wellness exams, is there some kind of a form to follow for medicare wellness physicals?
samyjw, here is what is covered under the Medicare annual preventive visits. This comes directly from the CMS publication explaining the annual preventive visits.

Yearly “Wellness” Visit
Starting January 1, 2011, if you’ve had Part B for longer than 12 months, you
can get a yearly “wellness” visit to develop or update a personalized prevention
plan based on your current health and risk factors. This includes the following• :

Review of medical and family history
• A list of current providers and prescriptions
• Height, weight, blood pressure, and other routine measurements
• A screening schedule for appropriate preventive services
• A list of risk factors and treatment options for you

How often is it covered?
Once every 12 months.

Your costs if you have Original Medicare.
You pay nothing for this visit if your doctor accepts assignment.

Hope this helps!!!
 
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samyjm13

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Thank you for information. But, if the note doesn't state it is a wellness exam and states it is an anuual PAP/pelvic and is medicare. Would I code 993xx ect. or send it back to the provider and tell him it doesn't Medicare guidelines for a wellness.

Samyjw
 

mshay134

Networker
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You would never code a 993xx, etc for Medicare, as you will not be paid for this. Educate the providers that this exam is not a "wellness" exam, it is a preventive exam. If they do a PAP/pelvic exam, then there should be a medical necessity DX code. If not, then there should not be a PAP/pelvic exam.
 

LindaEV

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Local Chapter Officer
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Kansas City, MO
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if it is a preventive pap/pelvic, then consider the G0101 / Q0091 codes- BUT there are specific guidelines on what needs to be done for this.

Also, Medicare covers an annual wellness visit (AWV) G0438 and G0349...but unless your doc KNEW he was doing that- sending it back will probably do no good, because these visits also have very specific requirements he will have to meet.

If you Google "annual wellness visit form" you will probably come up with a few.

I have attached forms that the AAFP have put out.

the HRA form is a requirement that came into effect on 1-1-2012. It must be completed with the AWV.

feel free to email me if you have additional questions.
lvargas@cassregional.org
 

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