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Thread: URGENT! IPPE and AWV

  1. #1

    Default URGENT! IPPE and AWV

    AAPC: Back to School
    I have an urgent question regarding the IPPE and AWV to Medicare, please. The CMS guidelines state that for the IPPE, the examination consists of the following (emphasis added by DB):

    measurement of patient's height, weight, BP,
    measurement of BMI,
    a visual acuity screening, and
    other factors deemed appropriate by the physician or qualified non-physician practitioner, based on the beneficiary's medical and social history and current clinical standards

    Now, here is the problem, based on our policies and procedures, we are required to ask each patient about signs/symptoms of inguial hernia as part of the ROS and past medical history. If the patient is positive for signs/symptoms of inguial hernia, then we automatically refer this patient to another provider for evaluation. This is because it is out of our scope of practice to perform an initmate exam on a patient.

    Even though we don't proceed with this part of the exam, we do fullfill all of the additional components of the IPPE/AWV.

    Now the question, can we still bill for the IPPE? Our legal department says that we can't bill for the IPPE in this situation because the guidelines strickly state "other factors deemed appropriate by the physician or qualified non-physician practitioner, based on the beneficiary's medical and social history and current clinical standards." They feel that because we don't proceed with the exam for the hernia, we are not full filling this requiremment of the IPPE and if we bill for a wellness visit that we referred to another provider because this part was out of our scope, we would be committing fraud.

    I am interested in others thoughts on this. Thanks.
    Dawson Ballard, Jr., CPC, CEMC, CPMA, CCS-P, CPC-P
    Compliance Auditor

  2. #2
    Join Date
    Apr 2007
    Marion, OH


    According to my quick reference guide from Medicare after the exam and end-of-life planning it states "based on the results of the review and evaluation services provided in the previous five components, provide education, counseling, and referral as appropriate." Since you are doing a referal based onthe review of medical and social history I believe that you can bill the IPPE.

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