Medicare developed the Initial Preventive Physical Examination (IPPE, also known as the “Welcome to Medicare” visit) (G0402) and initial and subsequent annual wellness visits (G0438 and G0439) to encourage Medicare patients to receive screenings and preventive care, and to work with their physicians to develop a personalized prevention plan. However, a Medicare wellness visit and a preventive visit should not be billed on the same date of service. As mentioned, some Medicare Advantage plans do cover the preventive medicine CPT codes in addition to Medicare wellness visits. Original (traditional) Medicare does not cover CPT codes 99381-99397, because Medicare has its own wellness visits with their own “G” codes and requirements. Reschedule physical exam initiating treatment changes or ordering immediate diagnostic tests close follow up scheduled. Patient has had a severe increase in symptoms. So acutely ill or with so many exacerbated chronic medical problems that you do not have time to also do a wellness visit. Review of treatment plan for multiple problems with no changes ifcomplex, multiple medications, and moderate risk of morbidity.įollow up on findings/patient's condition may be scheduled in following weeks. Patient's physical condition may have deteriorated since previous visits.Ĭhanges to treatment x-ray or lab tests for diagnosis (not screening) referral to a consultant. Remember to review status of stable problems and describe symptoms of poorly controlled problems. Multiple stable chronic problems significantly reviewed (current problems - not medical history). New headache, dizziness, abdominal pain, or dyspnea on exertion. Remember to show extra work to justify 99214 vs. Scheduled follow-up visit for multiple significant but stable problems. New problem with an uncertain prognosis, e.g., acute complicated illness.Ī significant exacerbation of one or more chronic illnesses. Remember to show management of chronic problem.īill 99214 (or 99204 for new patients) with preventive or wellness code Order labs refill existing prescriptions. There may be an unexpected abnormal finding on exam. Status of existing chronic conditions significantly reviewed, not just listed. Patient describes onset of acute, uncomplicated problem, or two minor problems. Remember to document significant, additional work beyond wellness visit requirements. No change in treatment scheduled screenings refilled prescriptions.Ĭonditions listed but not evaluated or managed.īill 99213 (or 99203 for new patients) with preventive or wellness codeĪn acute, uncomplicated illness at time of visit. Patient is well at home and has no complaints.Ĭhronic illness listed but not described, or described only in a few words.Įxam findings are normal or unchanged from previous exams. Would not have come in based on their symptoms, except that they had an annual exam scheduled. Stable chronic illnesses (not addressed during visit). In good health, with no chronic problems (basically “well”). Patient's status or medical history includes:
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