presented kristi a. gutierrez ccs p, cpc, cemccemc · preventive counseling visit ¾preventive...
TRANSCRIPT
Presented by: Kristi A Gutierrez CCS P CPC CEMCPresented by: Kristi A. Gutierrez CCS‐P, CPC, CEMC
ObjectiveUnderstand the documentation and coding requirements for different types of preventive services as required by CPT and CMS (Center for Medicare and as required by CPT and CMS (Center for Medicare and Medicaid Services)
AgendaAgenda
Standard Preventive visitPreventive visit with a problem‐oriented servicePreventive visit for a Medicare patient
Initial Preventive Physical Exam (IPPE)Medicare’s covered preventive screening services
Preventive counseling visitl lPre‐op Dental Clearance visit
Standard Preventive VisitStandard Preventive Visit(99381‐99397)
S l d b d d N E bli h d iSelected based on age and New or Established patientPreventive Medicine codes reflects an age and gender appropriate; appropriate;
Comprehensive H & P exam, history pertinent risk factorsCounseling/anticipatory guidance/risk factor reductionOrdering of appropriate immunizations or lab/diagnostic procedures included
Actual performance of these services should be billed separatelyp p y
Management of insignificant problemsSuch as prescription renewal for allergy meds or discussion about status of stable chronic conditions that don’t require additional workstatus of stable chronic conditions that don t require additional work
Well Visit ‐ CPT Codes
New Patient
Established Patient
Age < 1 99381 99391
Age 1‐4 99382 99392
A 8Age 5‐11 99383 99393
Age 12‐17 99384 99394
Age 18‐39 99385 99395g 39 993 5 99395
Age 40‐64 99386 99396
Age 65+ 99387 99397
Preventive visit with a ProblemPreventive visit with a Problem Oriented service
P ti t t i ifi t l i t Patient presents significant new complaint or new or established chronic condition during preventive visit
• Requires additional work to perform key components of E/M serviced d l k• History, Exam and Medical Decision Making
Problem oriented service should be clearly documented and distinct from the preventive visit Submit office visit E/M codes (99201‐99215)with modifier 25 in addition to the preventive service
Based on the additional work performed to evaluate the problemDiagnostic tests or additional services provided should be billed separatelyLink appropriate ICD‐9 code to applicable CPT
In order to distinguish between preventive and problem oriented services
The Preventive E/M visit with a ProblemThe Preventive E/M visit with a Problem Oriented service: Example
Preventive visit for Medicare patient(G0402)
Initial Preventive Physical Exam (IPPE ) click here for Quick Reference GuideEligible within first 12 months after Part B Medicare coverage begins
Once in a lifetime benefitOnce in a lifetime benefit7 Components of IPPE
1.Review medical and social history, 2 Potential risk factors for depression 2.Potential risk factors for depression, 3.Functional ability and level of safety4.Physical Exam 5.End‐of‐Life planning6.Education, counseling, and referral based on previous five components7.Education, counseling and referral for other preventive services
Medicare does not provide coverage for routine physical examsMedicare does not provide coverage for routine physical examsAfter the 12 month Medicare Part B enrollment period
Medicare covered screening servicesMedicare covered screening services
Screening services that are covered in absence of an ll dillness, disease, sign or symptom
Screening pelvic and breast examPSAPSAColorectal Cancer ScreeningScreening MammographyScreening Pap testsDiabetes Screening Cardiovascular Disease ScreeningCardiovascular Disease ScreeningMany more , see handout: Medicare’s Quick Reference Guide
Provides Billing codes and Frequency of services
Preventive Counseling VisitPreventive Counseling Visit
Preventive Medicine, Individual counselingPreventive Medicine, Individual counselingand/or risk factor reduction (99401‐99404)
Focus of a separate visit (from Preventive Medicine visit)May be reported separately from E/M service (99201‐99215)
Risk factor reduction used for persons without a specific Risk factor reduction used for persons without a specific illnesse.g. Family problems, diet and exercise, injury prevention, dental health, sexual practices, p
Time based codesPreventive Medicine, Group counseling (99411‐99412)
b d dTime based codes
Preventive Counseling Visit tPreventive Counseling Visit ‐ cont
Behavior Change Interventions, Individualg• Persons who have a behavior that is often considered an illness itself
Smoking and tobacco use cessation (99406‐99407)Smoking and tobacco use cessation (99406 99407)Alcohol and/or substance (other than tobacco) abuse structured screening (eg. AUDIT, DAST), and brief intervention services (99408 99409)intervention services (99408‐99409)• Involve specific interventions
• Assessing readiness for change, barriers to changeAd i i h i b h i• Advising change in behavior
• Assist by providing specific suggested actions• Motivational counseling and arrange for services and follow‐upTi b d dTime‐based codes
Pre op Dental Clearance visitPre op Dental Clearance visit
How do we bill for this type of service?Bill this as a consult (99241‐99245)
Follow consultation guidelinesI di h d h f l d hIndicate who requested the referral and whyWritten report to the requesting physician or appropriate source with consultants opinion and any services that were d d f dordered or performed
SummarySummary
Preventive medicine coding varies by type of visitPreventive medicine coding varies by type of visitStandard preventive visits are selected based on age and if patient is New or EstablishedHow and when to document and code a problem oriented visit with a preventive medicine visitCriteria for Medicare preventive visits vs covered Criteria for Medicare preventive visits vs. covered screening servicesPreventive counseling services (separate from Preventive medicine visit) are time based medicine visit) are time based Pre‐op dental clearance visits are billed and documented as consultations
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