# IPPE exam missing component



## AR2728 (Jan 28, 2013)

I was looking for some guidance on this issue through Medicare but couldn't find anything specific to this.  A phycisian did not document the required component of end-of-life planning.  The physician stated that the patient appeared very overwhelmed with all the screening components and the requested testing to be completed.  The patient did not expect the visit to be so involved and the physician feared that addressing this issue would have "put her over the top".  The physician did not even mention in any way the end-of-life planning to the patient.  

I know this is a required component of the IPPE.  I feel that had the physician attempted to speak with the patient on the issue of end-of-life planning and the patient declined-she then could bill the IPPE provided that was documented.  However, due to the fact that she did not mention this at all to the patient, I do not feel that we could bill the IPPE even if the physician documents the patients overwhelmed condition.

Thoughts on this??


----------



## ollielooya (Jan 28, 2013)

I thought that I had read along the way that this particular requirement had been deleted, and was just an option but NOT a requirement.  Please someone, correct me if I'm wrong on this?


----------



## cheermom68 (Jan 29, 2013)

It is still a requirement of the IPPE but not the AWV.

(5) End-of-life planning as that term is defined in this section upon agreement with the individual.


----------



## hbowens1 (Feb 20, 2013)

End-of-life planning is certainly still a requirement for the IPPE. If the physician did not document all of the requirement components required for this service it is not billable, regardless of the reason why it wasn't addressed.


----------



## AR2728 (Feb 21, 2013)

Thank you for your input.  In the end, we have not billed the service as an IPPE.


----------



## Stefanie (Mar 26, 2013)

It says "End-of-life planning is a required service, upon the beneficiary's consent.  end-of-life is verbal or written information provided to the beneficiary regarding:..."

Why couldn't you mail the patient an information piece, document that you did so in the patient's medical record. Wouldn't that count?  I think it would.


----------

