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Showing posts with label Preventive Visits. Show all posts
Showing posts with label Preventive Visits. Show all posts

Initial Preventive Physical Examination with EKG (IPPE)

Welcome to Medicare Preventive Visit

HCPCS/CPT Codes

  • G0402 – Initial preventive physical examination; face-to-face visit, services limited to new beneficiary during the first 12 months of Medicare enrollment
  • G0403 – Electrocardiogram, routine ECG with 12 leads; performed as a screening for the initial preventive physical examination with interpretation and report
  • G0404 – Electrocardiogram, routine ECG with 12 leads; tracing only, without interpretation and report, performed as a screening for the initial preventive physical examination
  • G0405 – Electrocardiogram, routine ECG with 12 leads; interpretation and report only, performed as a screening for the initial preventive physical examination

Who Is Covered

  • All new Medicare beneficiaries who are within the first 12 months of their first Medicare Part B coverage period

Frequency

  • Once in a lifetime
  • Must furnish no later than 12 months after the effective date of the first Medicare Part B coverage period

Covered ICD-10 Codes for CPT G0402

The specified below ICD codes are covered for CPT G0402 but may not be limited and some private payers having specific guidelines.

  • R93.811 Abnormal radiologic findings on diagnostic imaging of right testicle
  • R93.812 Abnormal radiologic findings on diagnostic imaging of left testicle
  • R93.813 Abnormal radiologic findings on diagnostic imaging of testicles, bilateral
  • R93.819 Abnormal radiologic findings on diagnostic imaging of unspecified testicle
  • R93.89 Abnormal findings on diagnostic imaging of other specified body structures
  • Z00.00 Encounter for general adult medical examination without abnormal findings
  • Z00.01 Encounter for general adult medical examination with abnormal findings
  • Z00.8 Encounter for other general examination
  • Z01.00 Encounter for examination of eyes and vision without abnormal findings
  • Z01.01 Encounter for examination of eyes and vision with abnormal findings
  • Z01.020 Encounter for examination of eyes and vision following failed vision screening without abnormal findings
  • Z01.021 Encounter for examination of eyes and vision following failed vision screening with abnormal findings
  • Z01.10 Encounter for examination of ears and hearing without abnormal findings
  • Z01.110 Encounter for hearing examination following failed hearing screening
  • Z01.118 Encounter for examination of ears and hearing with other abnormal findings
  • Z68.1 Body mass index [BMI] 19.9 or less, adult
  • Z68.20 Body mass index [BMI] 20.0-20.9, adult
  • Z68.21 Body mass index [BMI] 21.0-21.9, adult
  • Z68.22 Body mass index [BMI] 22.0-22.9, adult
  • Z68.23 Body mass index [BMI] 23.0-23.9, adult
  • Z68.24 Body mass index [BMI] 24.0-24.9, adult
  • Z68.25 Body mass index [BMI] 25.0-25.9, adult
  • Z68.26 Body mass index [BMI] 26.0-26.9, adult
  • Z68.27 Body mass index [BMI] 27.0-27.9, adult
  • Z68.28 Body mass index [BMI] 28.0-28.9, adult
  • Z68.29 Body mass index [BMI] 29.0-29.9, adult
  • Z68.30 Body mass index [BMI] 30.0-30.9, adult
  • Z68.31 Body mass index [BMI] 31.0-31.9, adult
  • Z68.32 Body mass index [BMI] 32.0-32.9, adult
  • Z68.33 Body mass index [BMI] 33.0-33.9, adult
  • Z68.34 Body mass index [BMI] 34.0-34.9, adult
  • Z68.35 Body mass index [BMI] 35.0-35.9, adult
  • Z68.36 Body mass index [BMI] 36.0-36.9, adult
  • Z68.37 Body mass index [BMI] 37.0-37.9, adult
  • Z68.38 Body mass index [BMI] 38.0-38.9, adult
  • Z68.39 Body mass index [BMI] 39.0-39.9, adult
  • Z68.41 Body mass index [BMI] 40.0-44.9, adult
  • Z68.42 Body mass index [BMI] 45.0-49.9, adult
  • Z68.43 Body mass index [BMI] 50.0-59.9, adult
  • Z68.44 Body mass index [BMI] 60.0-69.9, adult
  • Z68.45 Body mass index [BMI] 70 or greater, adult
  • Z71.84 Encounter for health counseling related to travel

Covered ICD-10 Codes for CPT G0403, G0404, G0405

The specified below ICD codes are covered for CPT G0403, G0404, G0405 but may not be limited and some private payers having specific guidelines.
  • R00.0 Tachycardia, unspecified
  • R00.1 Bradycardia, unspecified
  • R00.2 Palpitations
  • R00.8 Other abnormalities of heart beat
  • R00.9 Unspecified abnormalities of heart beat
  • R01.0 Benign and innocent cardiac murmurs
  • R01.1 Cardiac murmur, unspecified
  • R01.2 Other cardiac sounds
  • R03.0 Elevated blood-pressure reading, without diagnosis of hypertension
  • R07.1 Chest pain on breathing
  • R07.2 Precordial pain
  • R07.81 Pleurodynia
  • R07.82 Intercostal pain
  • R07.89 Other chest pain
  • R07.9 Chest pain, unspecified
  • R94.31 Abnormal electrocardiogram [ECG] [EKG]
  • Z13.30 Encounter for screening examination for mental health and behavioral disorders, unspecified
  • Z13.31 Encounter for screening for depression
  • Z13.32 Encounter for screening for maternal depression
  • Z13.39 Encounter for screening examination for other mental health and behavioral disorders
  • Z13.6 Encounter for screening for cardiovascular disorders
  • Z82.41 Family history of sudden cardiac death
  • Z82.49 Family history of ischemic heart disease and other diseases of the circulatory system

Medicare Beneficiary Pays as below,

G0402,

  • Co-payment/coinsurance waived
  • Deductible waived

G0403, G0404, and G0405,

  • Co-payment/coinsurance applies
  • Deductible applies

Annual Preventive and Wellness Visit Service

Preventive Service Codes


The annual preventive exam is a periodic, comprehensive preventive medicine evaluation (or reevaluation) and management of the patient.

The CPT Code selection is based on whether the patient is receiving an initial visit -"New Patient" or a periodic - "Established Patient" preventive service, as well as the patient’s age.
  • Initial Visits - 99381, 99382, 99383, 99384, 99385, 99386, 99387
  • Subsequent Visits - 99391, 99392, 99393, 99394, 99395, 99396, 99397
The Medicare insurance would be covered by "G" codes instead of the above codes. The details below,
  • Welcome to Medicare - G0402 (Within the one year from the patient enrolled in Medicare)
  • Initial Annual Wellness Visit - G0438 (After the 1st year of enrollment)
  • Subsequent Annual Wellness Visit - G0439

Initial Visits


Initial comprehensive preventive medicine evaluation and management of an individual including an" age and gender appropriate history, examination, counseling/anticipatory guidance/risk factor reduction interventions, and the ordering of laboratory/diagnostic procedures", New patient,
  • 99381 - Infant (age younger than 1 year)
  • 99382 - Early childhood (age 1 through 4 years)
  • 99383 - Late childhood (age 5 through 11 years)
  • 99384 - Adolescent (age 12 through 17 years)
  • 99385 - 18-39 years
  • 99386 - 40-64 years
  • 99387 - 65 years and older

Subsequent Visits


Periodic comprehensive preventive medicine reevaluation and management of an individual including an "age and gender appropriate history, examination, counseling/anticipatory guidance/risk factor reduction interventions, and the ordering of laboratory/diagnostic procedures," established patient,
  • 99391 - Infant (age younger than 1 year)
  • 99392 - Early childhood (age 1 through 4 years)
  • 99393 - Late childhood (age 5 through 11 years)
  • 99394 - Adolescent (age 12 through 17 years)
  • 99395 - 18-39 years
  • 99396 - 40-64 years
  • 99397 - 65 years and older

Included Services


Checking the status of "chronic conditions" and "refilling ongoing prescriptions" is expected during an annual preventive exam and does not warrant the billing of a separate problem-oriented E/M service.

If a chronic condition is not being well controlled, however, and decisions are being made as to how to treat the patient to improve control (changing the dosage of medications, changing to a new medication, etc.), this may substantiate a separate problem-oriented E/M service.

Documentation

  • Medical and family history
  • List of current medical providers
  • Height, weight, BMI, BP, and other appropriate routine measurements
  • Detection of cognitive impairment
  • Review risk factors – Review of functional ability
  • Establish a written screening schedule for the next 5-10 years
  • Establish a list of risk factors
  • Provide advice and referrals to health education and preventative counseling services

Tips - CPT G0402 & G0438 covered once in a lifetime for the patient.



See E/M 2021E&M guidelines

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