Primary Care Coding Alert

Send potential Medicare beneficiaries WTM appointment reminders

To make sure that you don't miss any possible Medicare initial preventive physical exam (IPPE) payment, take these expert-recommended actions:

1. Educate staff on the 2005 benefit. "Tell them that patients aged 62-65 may qualify for a covered physician exam (PE) provided the patient is new to Medicare," says Susan Callaway, CPC, CCS-P, an independent coding consultant and educator in North Augusta, S.C.

2. Add the new codes to your superbill. Make sure to point out that staff must code the IPPE with G0344 (Initial preventive physical examination; face-to-face visit, services limited to new beneficiary during the first six months of Medicare enrollment) and the ECG with G0366-G0368 (Electrocardiogram, routine ECG with at least 12 leads ... performed as a component of the initial preventive physical examination).
 
"If they instead report the service with 99387 (Initial comprehensive preventive medicine evaluation and management of an individual ... 65 years and over) or 99397 (Periodic comprehensive preventive medicine reevaluation and management of an individual ... 65 years and over), Medicare will kick out the code and deny payment," says Callaway.

3. Flag potential new Medicare patients. "Have staff pay attention to patients' birthdates," suggests Callaway. When patients who will be eligible for Medicare coverage in the next three to four months present at your office, staff should inform them of the new benefit.
 
Easy way: Most computer systems can generate birthday cards using patients' information. Send announcements four to six months before a patient's 65th birthday informing him or her of IPPE coverage, Callaway recommends. "The letter could explain the new benefit and suggest that the patient call your office to take advantage of the service."