Wiki IPPE vs. Preventative medicine

[lasonya]

If a patient presents for an IPPE but has been on Medicare for 18 months vs. which is over the 12 month threshold. How do you bill this visit since Medicare doesn't pay for preventative medicine codes anymore. Bill the preventative medicine code and get an ABN from patient, still bill the IPPE code anyway or bill an AWV code?

 

[mitchellde]

You will have to bill the AWV not the IPPE. This is covered in a med learn matters article but I have lost the link sorry, but if the patient did not receive the IPPE and the 12 months have past, then you use the initial AWV for the first time

 

[ehanna]

To further elaborate there are specific requirements for the AWV, it is not your normal physical, and you want to make sure this criteria has been met. If the patient wants a full physical you should make them aware they are non covered and get an ABN.

Emily

 

[HKOFOID]

To further elaborate there are specific requirements for the AWV, it is not your normal physical, and you want to make sure this criteria has been met. If the patient wants a full physical you should make them aware they are non covered and get an ABN.

Emily

I am having a problem where my software company says Medicare told them to make it to where we are no longer available to even send them a claim with the normal physical code for a denial to bill the patient if they signed an ABN. Do you know if we can just bill the patient for the physical directly without billing Medicare if the patient singed an ABN?