Wiki Welcome to Medicare Exam, or IPPE ?

[Orthocoderpgu]

Is anyone familiar with "Welcome to Medicare Exams"? The correct name is Initial Preventive Physical Exam. Patient has only been on Medicare for 6 months and came to our clinic as a new patient. The pt has two stable chronic illnesses but the doc did a comp hx, comp exam. If I break out the systems that were reviewed for the medical conditions, can I bill the remainder of the visit as a welcome to Medicare visit...and if so, what DX would you use for the welcome to Medicare visit? Thanks for your help!!

 

[RebeccaWoodward*]

I think my first question would be...why is the patient coming in? For the IPPE visit or to establish care. One doesn't always interchange with the other. As for the IPPE...The HCPCS code is G0402. I noticed you mentioned that the patient has been on Medicare for 6 mo. Effective for dates of service on or after January 1, 2009, Medicare provides coverage of the IPPE for all newly enrolled beneficiaries who receive the IPPE within the first 12 months after the effective date of their Medicare Part B coverage. It was previously within the first 6 months after their effective date with Medicare Part B. The IPPE has requirements that must be met in order for the IPPE to be covered. There is a quick reference grid that provides the required diagnosis codes for each component rendered. The link below provides some great information as well as some Q/A.

http://www.cms.hhs.gov/WelcometoMedicareExam/02_Provider Resources.asp

 

[Orthocoderpgu]

Thanks for your help and the links are very helpful. I've been looking for them but never found them. The patient came in to establish care. The patient does have HTN and anxiety, but the doc did a comprehensive exam. So I'm trying to figure out how to code this so that the office visit is not over-coded.