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Annual Visits for Medicare Patients

  1. #1
    Question Annual Visits for Medicare Patients
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    I am needing help understanding the medicare preventative services. I understand that Medicare covers a "welcome to medicare" physical. and they are also covering a physical every 2 years (w/high risk being covered yearly??), and now with the healthcare reform as of Jan. 2011 they will cover them yearly. Until then lets say a pt comes into the office for an "Annual" visit when medicare is not going to cover the visit, how would you code that? here is an example visit:
    HT: 5'0''
    WT: 119
    BP: 160/92
    Allergy: NKDA
    CC: Annual
    HPI: 69 yo P2 PM no bleeding, no D/C

    Last Mammo: 2/2010
    Last Exam: 2/3/09
    Last Colonoscopy: 2008
    Last bone density: 11/18/08


    NECK: NL
    Breast: Sym
    ABD: Soft, NT
    UT: AV, NT
    CX,AD: no masses
    Rectal: no masses

    Hematest (-)
    UA: (-)

    Assess and Plan:
    SBE/ year
    Fosamax 70mg
    Gen Cx

    Codes billed:


  2. Default
    We code our Medicare GYN physicals w/ G0101, as a pelvic exam is being done. our practice is strickley OB/GYN and we do not do the "The Welcome to Medicare" physicals. Hope this gives you some direction.

  3. #3
    First Hill, Seattle WA
    Default 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 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.

  4. #4
    Thank you ladies very much for your help. it has helped me clarify things.

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