Medicare Complete Physical Examinations vs office visits vs paps, etc.
If a CPE was done then that is what needs to be billed-CPEs as an excluded benefit will be the patients' responsibility until Jan 2011.
If a pap/pelvic/breast exam were done, these can be carved out from the cost of the CPE (thus reducing the CPE cost to the pt).
As per HCPCS 2010:
G0101=Cervical or vaginal cancer screening; pelvic and clinical breast examination. Can be reported with an E/M code when a separately identifiable E/M service was provided.
Q0091=screening Papanicolaou smear; obtaining, preparing and conveyance of cervical or vaginal smear to laboratory. One pap test is covered by MCR every two years for low risk patients and every one year for high risk patients. Q0091 can be reported with an E/M code when a separately indentifiable E/M service is provided.
The guidelines for a "Welcome to Medicare Exam" can be found at http://www.cms.gov/home/medicare.asp under the "Prevention" tab on the lower right hand side of the screen. There are only seven elements that are required for an IPPE-this is not a full-on head to toe physical exam.
MCR website also has execellent educational and reference tools to understand MCR guidelines and benefits.
Jeannie Ryder, CPC, CEMC
AHIMA-Approved ICD-10-CM/PCS Trainer