IPPE elements
IPPE or Welcome to Medicare has certain "elements " that need to be met , see below :
At a minimum
● Past medical/surgical history (experiences with illnesses, hospital stays, operations, allergies,
injuries, and treatments)
● Current medications and supplements (including calcium and vitamins)- UPDATE all med - must indicate if the meds were reconciled
● Family history (review of medical events in the beneficiary’s family, including diseases that may
be hereditary or place the beneficiary at risk)
● History of alcohol, tobacco, and illicit drug use ( does pt use alcohol -list how often ) ( tabacco current smoker , how many and what does the pt smoke ) and list yes or no for any illicit drug use or any of the previous questions.
● Diet ( does the pt fallow a low sodium diet, BRAT diet, low glycemic diet , puree etc )
● Physical activities ( does the pt walk , does any exercises .. )
obtain current or past experiences with depression ( YOU ONLY GET REIMBURSE FOR G0444 when is done with the Welcome to medicare) or other mood disorders, use any appropriate screening instrument for beneficiaries without a current diagnosis of depression from various
available standardized screening tests recognized by national professional medical organizations
Please keep in mind that the SCREENING needs to be perform for patients that do not have an active diagnosis of Depression or any mood disorders - G0444 is the code to be used and the screening tool can be the PHQ-2 or PHQ-9 , the provider needs to document the tool administered. Depression screening is only reimbursed during the Welcome to medicare or IPPE
Use appropriate screening questions or standardized questionnaires recognized by national
professional medical organizations to review, at a minimum, the following areas:
● Activities of daily living ( does the pt need help with showering, eating, walking ( list any DME's ) , document who provides the help and how often)
● Fall risk ( has the pt fallen in the last year ? How many times ? how did the pt fall ( slipped , tripped , loss balance , dizziness due to meds or condition) there is an assessment available from the CDC called "STAY INDEPENDENT" or STEADI
● Hearing impairment ( is the pt hard of hearing ? , does the pt use hearing aids , document referrals to specialist )
● Home safety ( does the pt live alone, fire alarm, CO2 monitor , life support button- provide information, family support )
Obtain the following:
● Height, weight, body mass index, and blood pressure
● Visual acuity screen ( if pt uses glasses or have any diagnosis of eye disease list when was the last eye exam and who follows the pt )
● Other factors deemed appropriate based on the beneficiary’s medical and social history and
current clinical standards ( THIS IS VERY IMPORTANT - SPECIALLY when you have pt's with Chronic conditions and comorbitities )
for Diabetic pts please list /order any blood work needed for DM pt's , who is the endo specialist , does the pt have any complications of DM, has
the pt seen a renal specialist , neurologist , eye doctor , FOOT doctor
If a patient has heart conditions and HTN ( review your guidelines for 2017) there is now an assumed "casual relationship" between HTN and
heart failure ( CAT I50. )
For pt's that suffer CKD -stage must be listed and last GFR and document whether or not the pt is on dialysis
Osteoporosis - when was the last DEXA test , is the pt under medications , who follows this DX ?
Pain management -
End-of-life planning is verbal or written information provided to the beneficiary about: VERY IMPORTANT - EVEN IF THE PT REFUSES OR DOESNT HAVE ANYBODY IN MIND TO CARRY HIS/HER WISHES PROVIDER NEEDS TO DOCUMENT THAT THE INFO WAS PROVIDED . IF PT DOES HAVE AN ADVANCE DIRECTIVE try to obtain a copy ( document if pt refused to provide doc but at least document the name of the person or whether or not pt would like life support )
● The beneficiary’s ability to prepare an advance directive in case an injury or illness causes the
beneficiary to be unable to make health care decisions
● Whether or not you are willing to follow the beneficiary’s wishes as expressed in an
advance directive
Based on the results of the review and evaluation services in the previous components, provide
education, counseling, and referral as appropriate
does the pt need obesity consultation ( specially for Diabetic- this is benefit that sometimes is cover for medicare pt's )
Smoking consult ( you get reimbursed for this )
Depression referral
Pain management referral for chronic pain ( new guidelines indicate PCP's cannot longer prescribe pain meds for more than 14 days i think - same
for medications that treat anxiety , depression since they are considered highly addictive and puts pt's at a higher risk for falls )
Includes a brief written plan, such as a checklist, for the beneficiary to obtain:
● A once-in-a-lifetime screening electrocardiogram (EKG/ECG), as appropriate ( there is a preventive code for pt's that do not have a diagnosis that warrants an EKG and is covered once during a life time G0403 - use this under the IPPE and the pt comes any other time you can code a regular EKG with SS
● The appropriate screenings and other preventive services that Medicare covers
Based on my experience and the fact that i helped revamp the wellness visit in my previous office i came to the conclusion that performing an IPPE and a AWV is a very complex process , there are a lot of "elements " to follow and Document in order to be compliant with CMS , most practices dont even give their pt's a health risk assessment or provide a summary of the screenings needed or simply a summary of the visit , but be certain that is not impossible to accomplish !!