Wiki Missing components of IPPE or AWVs

[Rita B. Conley]

I have a general question. If a component is missing from the IPPE or AWV required documentation elements (for example, the initial AWV requires a list of the patient's health care providers...what if this piece wasn't documented), how strict would you be relative to allowing the billing of the AWV for this visit with feedback/education to the provider and if pattern develops, then you would not allow G0438? I cannot find any guidance from Medicare on what to "down code" to...would I drop the visit to a preventive medicine code 99381-99397?

In Medicare's Guide to Preventive Services, under the AWV section, the documentation requirements read, "Documentation must show that the health professionals provided, or provided and referred, all required components of the AWV...," so with this, is it "black and white" that you would not allow the AWV and would then look to see if all elements of a preventive medicine service are covered so you could assign those codes instead?

I'd just like to seek opinions from others in this realm.

 

[britbrit852003]

When this happens in my office we do not bill anything even a 99396-99397 as AVW/IPPE are very different than an CPE.
We've not billed for an AWV when the provider did not do a cognitive test (clock draw). Even if they did everything else if they miss even one element its not billable.

 

[Rita B. Conley]

That's my take on it when you read Medicare's guidelines, but I just wanted to get a general consensus from other coding staff. Thanks for taking the time to respond, Brittany.

 

[sdeaton]

If the patient presents for IPPE or AWV, that's what they're there for, right? Medicare is clear about the "required elements" of these services and each element should be met (whether provided or provided and referred). If not met, nothing should be billed since we were not given any coding alternatives for missing an element.

As I understand the IPPE and AWV; these are not "physical" exams but rather detailed "interviews" and would not meet the requirements of the 993XX preventive codes.

There was a very helpful article and outline of the required elements in a 2011 Coding Edge, not sure which month.

If you locate any contradictory and/or enlightening information, please share with us!