Internal Medicine Coding Alert

Published on Wed Jan 07, 2009 PDF

You'll get more bang for your IPPE buck in 2010.

Internal medicine coders got a dose of good news when Medicare announced 2010 guidelines for its initial preventive physical examination (IPPE) at the CPT and RBRVS 2010 Annual Symposium in Chicago.

The $kinny: Medicare increased the value of the "Welcome to Medicare" examination, and kept a couple of newer rules that favor both patient and practice. Here's the lowdown on what IPPE elements should catch your eye in 2010.

The relative value units (RVUs) of the IPPE has been raised significantly; in 2010 Medicare's G0402 (Initial preventive physical examination; face to face visit, services limited to new beneficiary during the first 12 months of Medicare enrollment) code is worth 2.30 RVUs. Last year, G0142 was worth 1.34 RVUs, confirmed Kenneth Simon, MD, MBA, FACS, senior medical officer for CMS's Hospital and Ambulatory Policy Group during the Chicago conference.

In other words: In 2009, G0402 was worth about as much as a 99203 (Office or other outpatient service for the evaluation and management of a new patient, which requires these 3 key components: a detailed history; a detailed examination; medical decision making of low complexity ...) service. In 2010, the same service will be worth about as much as a 99204 (... a comprehensive history; a comprehensive examination; medical decision making of moderate complexity ...) service. "CMS received comments from several medical groups that this service [IPPE] was undervalued," explained Simon.

CMS also made sure that two major changes from last year remained intact. As the G0402 descriptor indicates, patients have 12 months from their enrollment dates to receive an IPPE. Before 2009, new Medicare patients had a six-month window.

Also: The internist is not required to perform an electrocardiogram (ECG) for G0402, another major 2009 change that Simon confirmed for 2010.

If the internist does provide a patient with a "Welcome to Medicare" exam and an ECG during the same session, you can report them separately.

On these claims, you'll report G0402 for the IPPE and one of the following ECG codes, depending on the specifics of the encounter:

• G0403 -- Electrocardiogram, routine ECG with 12 leads; performed as a screening for the initial preventive physical examination with interpretation and report

• G0404 -- ... tracing only, without interpretation and report, performed as a screening for the initial preventive physical examination

• G0405 -- ... interpretation and report only, performed as a screening for the initial preventive physical examination.