Presented by Karrie May, CPC April, 2012 1 Karrie May, CPC Been in the medical field in some capacity for over 20 years. Currently work for a large multi specialty medical group as a provider educator. 2 1
TOPICS Welcome to Medicare visit Annual Wellness Visit, Initial Annual Wellness Visit, Subsequent Preventive Care covered by Medicare 3 WELCOME TO MEDICARE VISITS Medicare covers the Welcome to Medicare visit within the first 12 months of patient s coverage with Part B. Initial Preventive Physical Exam (IPPE) is to review the patient s health. To provide education and counseling about preventive services, and referrals for other care if needed. As of January 1, 2011, there is no co pay or deductible for this visit. 4 2
WELCOME TO MEDICARE VISITS cont IPPEincludes the following components: Height, weight, blood pressure and visual acuity Review of Medical & Social History Review of potential risk factors for depression, functional abilityand and level of safety withthe the goal of health promotion and disease detection EKG (no longer a mandatory part of the IPPE, but it may be performed as an optional one time service as a result of a referral arising out of the IPPE. ) 5 WELCOME TO MEDICARE VISITS cont IPPEincludes the following components: Education, counseling, and referral with respect to screening and preventive services currently covered by Medicare Part B Covered Immunizations (review & future plan) Body mass index End of life planning upon an individual s consent. 6 3
7 Step 1: Acquire History 8 4
Step 2: The Examination 9 Step 3: Education and Counseling 10 5
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WELCOME TO MEDICARE VISITS cont When patients call to schedule this visit they will probably ask for their free physical. This is not a head to toe physical. Only requirement is height, weight, and BMI. A complete physical doesn t require as much paperwork or as much time as the IPPE. The RVU s for the IPPE are higher than for a complete physical. WELCOME TO MEDICARE VISITS cont This is a once in a lifetime benefit only covered during the first 12 months of patients part B coverage. The patient may be eligible for an abdominal aortic aneurysm (AAA) screening. It must be ordered at the time of the Welcome to Medicare Visit (IPPE). Must be performed within six to twelve months from the visit. Once in a lifetime benefit. If patient is an established patient to the practice, they can still receive the IPPE. The IPPE has no co pay or deductible as of January 2011. 16 8
WELCOME TO MEDICARE VISITS cont Code G0402: Initial Preventive Physical Examination (IPPE); face to face visit, services limited to new beneficiaries during the first 12 months of part B eligibility. ICD 9 code: V70.0 IPPE EKG codes: G0403: EKG tracing and report G0404: EKG tracing only G0405: EKG interpret & report only ICD 9 Codes: V81.0, V81.1, V81.2 17 WHO CAN PERFORM IPPE The IPPE must be furnished by a health professional, meaning a physician, a qualified physician assistant, nurse practitioner or clinical nurse specialist. Can also be performed by a medical professional, including health educators, registered dietitians, nutrition professionals, or a team of such medical professionals who are working under the direct supervision of a physician. All must be licensed and this must be within the scope of their practice 18 9
Annual Wellness Visits As of 2011, Health care reform extended the preventive focus of Medicare to provide coverage for Annual Wellness Visits (AWV) This is not a physical it is an evaluation of the patients health and wellness. Many patients will call and ask for their free physical, it is very important for the patient to know that this is not a head to toe physical. 19 Annual Wellness Visit for Medicare Who is Eligible for an Annual Wellness Visit? A beneficiary that has not received either an initial preventive physical examination, IPPE or an AWV within the past 12 months. 20 10
What is Included in an Initial AWV? Etblih Establish or update dt the individual s id medical and family history Depression screening List of individual s current medical providers, suppliers and ll ib d di ti all prescribed medications Record Vitals to include height, weight, body mass index, blood pressure and other routine measurements 21 What is Included in an Initial AWV? Functional ability includes i l hearing test t Detect any cognitive impairment Create a schedule of Medicare s screening and preventive services for next 5 10 yrs Any required referrals to treat potential health risks 22 11
23 What is included in the initial AWV Step 1: Acquire History 24 12
What is included in the initial AWV Step 2: The examination 25 What is included in the initial AWV Step 3: Counsel Beneficiary 26 13
What is Included in a Subsequent AWV? An update of the individual s medical/family history. An update of the list of current providers. Measurement of an individual s height, weight, BMI, BP, and other routine measurements. 27 What is Included in a Subsequent AWV? An update of the individual s medical/family history. An update of the list of current providers Measurement of an individual s height, weight, BMI, BP, and other routine measurements. 28 14
What is Included in a Subsequent AWV? Detection of any cognitive impairment. An update to the written screening schedule. An update to the list of risk factors. Furnishing of personalized health advice. 29 30 15
Annual Wellness Visit G0438 Annual wellness visit, iit first visit. iit G0439 Subsequent annual wellness visit Preventative Medicine codes 99387 and 99397 better known to offices as Complete Physical Exams or Well Checks for 65 and older, remain a non covered, service from Medicare. 31 Preparing Eligible Medicare Beneficiaries for the AWV Providers can help eligible Medicare beneficiaries get ready for their AWV by encouraging them to come prepared with the following information: Medical records, including immunization records; Family health history, in as much detail as possible; A full list of medications and supplements, including calciumand and vitamins how often and how muchof each is taken; and A full list of current providers and suppliers involved in providing care. 32 16
Preparing Eligible Medicare Beneficiaries for the AWV A new requirement for 2012 is a Health Risk Assessment (HRA) The purpose of the HRA is to determine the health behaviors and risk factors of the patient. Must be completed by the patient before the face to face encounter with the physician. 33 Preparing Eligible Medicare Beneficiaries for the AWV CMS has not designated a specific form but it does have 34 required elements that need to be addressed. The CDC has collaborated with the Centers for Medicare and Medicaid Services (CMS) to develop an evidence informed framework document for this type of assessment, A Framework for Patient Centered Health Risk Assessments: Providing Health Promotion and Disease Prevention Services to Medicare Beneficiaries. (PDF, 3 MB) http://www.cdc.gov/policy/opth/hra/ 34 17
Preparing Eligible Medicare Beneficiaries for the AWV Form must be written at sixth grade literacy level, must be able to complete in 20 minutes. This form can be completed by the patient or the caregiver and it must be completed before the face to face encounter with the physician. HRA can be accessed via internet, phone, or paper based. Must be accessible to all in a language familiar to them. 35 Preparing Eligible Medicare Beneficiaries for the AWV If the HRA is filled out in the physicians office the office staff can help the patients complete the form. Medicare has increased RVUs for this procedure. Medicare does not expect this to be a brief visit. 36 18
Annual Wellness Visit Points to Remember No specific required diagnosis code. Use a preventive diagnosis code (V70.0) The AWV is an excellent opportunity to gain an overall view of your patient s health status, and to ensure you ve documented all clinical conditions that are relevant. 37 Annual Wellness Visit Points to Remember Medicare allows payment for a medically necessary Evaluation and Management (E/M) service on the same date as AWV, provided it is clinically appropriate. The patient will owe a co pay for this service. Some of the components of a medically necessary E/M service may have been part of the IPPE or AWV and should not be included when determining the most appropriate level of service to be billed. The E/M visit should be coded with the addition of modifier 25. 38 19
Annual Wellness Visit Points to Remember If the patient wants to schedule an AWV or IPPE and they have a lot of medical concerns, suggest they schedule a medical visit first and then schedule the AWV or IPPE after that. If patient is insisting on physical (head to toe) suggest the AWV or free visit first, and if they still feel they need the physical they can schedule it. Complete physical is a non covered service, the patient will be responsible for payment in full. If the patient desires an annual physical, complete an ABN to show patient the cost. 39 Annual Wellness Visit Points to Remember Do not add modifier 25 to Medicare G code. Use additional codes to report the following services during an IPPE or AWV: 1. Screening Pelvic Exam (Code G0101, ICD 9 code V72.31) 2. Screening Pap Tests (Code Q0091, ICD 9 code V72.31) 3. Screening Prostate Cancer (code G0102, ICD 9 code V76.44) 40 20
Annual Wellness Visit Points to Remember G0402: Welcome to Medicare visit, IPPE, first 12 months of eligibility for part B G0438 Annual wellness visit (AWV), Once a year or 12 months after Welcome to Medicare visit G0439 Annual wellness visit (AWV), subsequent visit, 12 months after the last AWV 41 Covered Preventive Services Pneumonia, flu, hepatitis B vaccines Screening mammography, Pap smears, pelvic exam Prostate cancer screening Diabetes screenings test, only if there is not a current diagnosis of diabetes Medical Nutrition t Therapy eapyservices (Diabetes abetes& Kidney disease RD) 42 21
Covered Preventive Services Bone mass measurement (Every 24 month for patient s at risk More frequently if medically necessary) Flexible sigmoidoscopy, colonoscopy Cardiovascular disease( Blood Test every 5 years) Ultrasound screening for abdominal aortic aneurysm (AAA only covered at time of IPPE) HIV testing 43 Covered Preventive Services Smoking cessation services Fecal Occult blood test Welcome to Medicare Visit Yearly Wellness Exam 44 22
Covered Preventive Services New Preventive Services covered for 2012 Counseling for Alcohol cessation Counseling for Obesity Screening for sexually transmitted diseases 45 46 23
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Resources AAFP:American Association of Family Practice http://www.aafp.org/online/en/home/publications/journals/f pm/preprint/healthriskassessment.html CDC: Center For Disease Control http://www.cdc.gov/policy/opth/hra/ Http://www.medicarehealthassess.org/ http://www.howsyourhealth.org/ https://www.cms.gov/mlnmattersarticles/downloads/mm7079.pdf 49 Medicare covered preventive services 2012 QUESTIONS? Kmaycpc@yahoo.com 50 25