Internal Medicine Coding Alert

Good news: 'Happy retirement' no longer comes with an unwelcome present.

Patients who become eligible for Medicare now have a new incentive to visit your internist for their "Welcome to Medicare" exams.

As of Jan. 1, the Medicare deductible does not apply to the Welcome to Medicare exam, announced Amy Bassano, MA, director of the CMS hospital and ambulatory policy group, in "Medicare Physician Payment Schedule 2009 Changes and Beyond" at the CPT and RBRVS 2009 Annual Symposium in Chicago. "This program aspect caused a lot of criticism."

Hooray: Patients who come in for the exam will not have the allowed charge applied to meeting their deductible. Since this is typically the beneficiary's first charge, the exam was often the patient's responsibility before 2009, when the Medicare deductible did apply to the service.

You can also forget struggling with reporting the initial preventive physical examination (IPPE) when your physician does not order an ECG. "We removed the ECG requirement," from the mandated services that must be included in the IPPE benefit, Bassano explains. This will be an educational, counseling, and referral service to be discussed with the individual and ordered by the physician, if necessary.

Splitting out the ECG made using the old G codes complicated (G0344, Initial preventive physical examination; face-to-face visit, services limited to new beneficiary during the first six months of Medicare enrollment; G0366, Electrocardiogram, routine ECG with 12 leads; performed as a component of the initial preventive examination with interpretation and report; G0367, Tracing only, without interpretation and report, performed as a component of the initial preventive examination; and G0368, Interpretation and report only, performed as a component of the initial preventive exam-ination). As of Jan. 1, you'll report the IPPE and the ECG with four new G codes.

Step 1: Code the IPPE with G0402 (Initial preventive physical examination; face-to-face visit, services limited to new beneficiary during the first 12 months of Medicare enrollment). Medicare enrollees now have 12 months instead of 6 months to obtain their Welcome to Medicare exam, points out Jill M. Young, CPC, CPC-ED, CPC-IM, with Young Medical Consulting LLC in East Lansing, Mich.

Step 2: Based on the internist's role in providing the total ECG, its equipment, or its interpretation and report, assign:

• 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.

With the IPPE, the physician will have to perform one additional required service, and may add another.

"The physician is supposed to take the patient's body mass index (BMI) measurement," Young says. You can use ICD-9 codes to document compliance with this addition.

Your doctor may also discuss end-of-life plans with the patient if she so desires.