Whew....... Now that the holidays are over, we are in the midst of the Mid-January slump… so we really need to re-charge our “coding batteries” and get back to it!
I also want to extend a warm welcome to my new blog-site readers, and a big THANK YOU to my continuing supporters. You make it all worth it! I'm a firm believer is sharing the information - continue your education!This week I have included the link for the CPT errata for the corrections to CPT 2011 that didn’t get put into the printed volumes. (see below)
This is a PDF file, that you can download and keep on your computer, or print out and file into your CPT books. Be sure to review this info carefully.... you never know when it might be applicable to you or your practice.
This week I've had inquiries regarding where to find information on a "coding handbook". It was so coincidental, as I was able to send them a copy of my “coding manager handbook”… I have it available on PDF file. If you are interested, please send me an e-mail. I’m happy to share.
I originally wrote this for a national publishing company, but was unable for it to go to press due to the complex economic downturn. So if you’re interested, please let me know. It really is a “basic handbook” for all you’ll need to know to work in or manage a coding department.
Anyway… The hot-topic for today is the new Medicare wellness codes for 2011
If you want the detailed information on this, please check out the info direct from the CMS website(s). http://www.cms.gov/MLNMattersArticles/downloads/MM7079.pdf and site http://www.cms.gov/MLNProducts/downloads/MPS_QRI_IPPE001a.pdf
The “Welcome to Medicare” exam commonly referred to as the IPPE (code G0402-G0405) is still in effect, and applicable only for the first 12 calendar months of a beneficiary's eligibility and should be coded as
IPPE HCPCS CODES
BILLING CODE DESCRIPTORS
Initial preventive physical examination; face-to-face visit, services limited to new beneficiary during the first 12 months of Medicare enrollment
Electrocardiogram, routine ECG with 12 leads; performed as a screening for the initial preventive physical examination with interpretation and report
Electrocardiogram, routine ECG with 12 leads; tracing only, without interpretation and report, performed as a screening for the initial preventive physical examination
Electrocardiogram, routine ECG with 12 leads; interpretation and report only, performed as a screening for the initial preventive physical examination
Below are the new 2011 HCPCS codes for a “wellness” type of exam.
G0438 - Annual wellness visit, includes a personalized prevention plan of service (PPPS), first visit, (Short descriptor – Annual wellness first)
This will need to be coded the FIRST time the patient has this performed
Can only be billed ONCE in a beneficiary’s lifetime
This code G0438 will be denied if billed within 12 months of a beneficiary’s eligibility to Medicare, as the beneficiary would be eligible for the IPPE “welcome to Medicare exam”. Please see criteria above for the IPPE exam.
G0439 - Annual wellness visit, includes a personalized prevention plan of service (PPPS), subsequent visit, (Short descriptor – Annual wellness subseq) will be implemented January 1, 2011, through the Medicare Physician Fee Schedule Database (MPFSDB) and Integrated Outpatient Code Editor (IOCE).
This will need to be coded SUBSEQUENT yearly if the G0438 was billed or coded previously.
This is not to be billed more than 1 time within a previous 12 months
This code G0439 will be denied if billed within 12 months of a beneficiary’s eligibility to Medicare, as the beneficiary would be eligible for the IPPE “welcome to Medicare exam”.
The reimbursement for these procedures equate closely to the reimbursement for a 99214 level office E&M. I encourage you to carefully review the criteria, and make sure that you are documenting and coding appropriately for these visits. In addition, if you have performed a “separately identifiable” E&M service, this can be billed. The caveat to this is that the separate E&M service was/is medically necessary, and is well supported.
Till next time……….. HAPPY CODING!!