Medicare IPPE, Initial & Subsequent AWV

Medicare Initial Preventive Physical Exam (IPPE)

• "Welcome to Medicare" visit.

• First 12 months of the beneficiaries eligibility with Medicare.

• Can not be done by Telehealth.

• Copay & Deductible are waived.

Documentation requirements

• Review of medical & social histories.

  • Illnesses, Hospital stays, operations, etc

  • Current medications & supplements

  • Family histories

  • Diet

  • Physical Activities

  • Alcohol, tobacco & illegal drug use

• Review for potential depression risk factors

  • PHQ-9

  • GDS

  • Any standard screening tool

• Review of patient functional ability & safety level

  • Ability to perform daily living activities

  • Fall risks

  • Hearing impairment

  • Home safety

• Exam

  • Height, weight & BMI

  • Visual acuity

  • Other factors reviewed deemed appropriate based on medical & social histories and current clinical backgrounds

• End of Life Planning, on patient agreement

  • Ability to prepare an advance directive, in case of illness or injury that would prevent the beneficiary from making health care decisions

  • If you, the Provider, agree to follow the advance directives

• Review current opioid prescriptions

  • Review of any opioid risk factors

  • Evaluate any pain severity & current treatment plan

  • Provide non-opioid treatment factors

  • Provide referrals to specialist, as appropriate

• Screen for potential substance use disorders

  • Review of the patients SUD risk factors, as appropriate, refer them to treatment

• Educate, counsel & refer based on previous components

  • Based on the review & evaluation, provide appropriate education, counseling & referrals

• Educate, counsel & refer for other preventive services

  • Include a brief written plan for the patient to get:

    • Once-in-a-lifetime screening electrocardiogram (ECG), as appropriate

    • Appropriate screenings and other covered preventive services

IPPE Coding

• G0402 - IPPE; face to face visit

• G0403 - Routine ECG with 12 leads; performed as a screening for the IPPE with interpretation & report

• G0404 - Routine ECG with 12 leads; tracing only, performed as a screening for the IPPE, without interpretation & report

• G0405 - Routine ECG with 12 leads; interpretation and report only, performed as a screening for the IPPE

• IPPE has no required diagnosis. Submit with any appropriate ICD-10 codes, per the patient's exam.

Medicare Initial & Subsequent Annual Wellness Visit (AWV)

• Second & Third year of the beneficiary's eligibility with Medicare.

• Can be done by Telehealth

• Copay & Deductible are waived

Documentation Requirements

• Health risk assessment

• Medical & family histories

• List of current providers & suppliers

• Measure

  • Height, Weight & BMI

  • Other measurements based on medical & family histories

• Assess cognitive function

• Review depression risk factors

• Review patients' functional ability & level of safety

• Establish a written screening schedule

• Establish the patients list of risk factors & conditions, primary, secondary or tertiary interventions'

• Provide personalized patient health advice & appropriate referrals to health education or preventive counseling services

• End of Life Planning, on patient agreement

• Review current opioid prescriptions

• Screen for potential substance use disorders

Initial/Subsequent AWV Coding

• G0438 - AWV; includes a personalized prevention plan, initial visit

• G0439 - AWV; includes a personalized prevention plan, subsequent visit

• AWV has no required diagnosis, to be covered. Submit with any appropriate ICD-10 codes, per the patient's exam.

Summary:

The services that are missed or deferred most often are the Visual Acuity (IPPE) & Cognitive Function (AWV). If any one of these requirements, listed above, are not documented within the medical record, it would deem the service unbillable.

If you need assistance with coding, billing or documentation support, please contact us.