Cardiology Coding Alert

Question: I am confused about coding for "Welcome to Medicare" (WTM) exams. How can I tell if the cardiologist satisfied all of the code's requirements?

Minnesota Subscriber

Answer: WTM exams are much less frequent and more involved than standard preventive medicine services. Patients can receive the exam only once per lifetime, and it has to happen in the first six months of the patient's Medicare enrollment. For this exam, you'll report G0344 (Initial preventive physical examination; face-to-face visit, services limited to new beneficiary during the first six months of Medicare enrollment).

The cardiologist needs to provide the following documentation for the patient during the encounter:

• a medical, family and social history

• a depression screening

• a review of the patient's functional ability and safety level

• a physical exam

• education, counseling and referral based on exam results

• a written plan recommending screening or preventive services for the patient

• an electrocardiogram. If the cardiologist does not perform the test, he must order it and document the results on the medical chart.

EKG alert: If the cardiologist performs the EKG in the office using his own equipment, you can report G0366 (Electrocardiogram, routine ECG with 12 leads; performed as a component of the initial preventive examination with interpretation and report) in addition to G0344.

If he performs only the EKG tracing, report G0367 (Tracing only, without interpretation and report, performed as a component of the initial preventive examination) with G0344. When the cardiologist supplies interpretation and report only, report G0368 (Interpretation and report only, performed as a component of the initial preventive examination) with G0344.

Note: For WTM exams, Medicare payers look for two codes to ensure that the physician performed all the exam's components: G0344 for the examination and counseling components, and G0366-G0368 for the EKG.