Coding Cues: Initial preventive physician examination is a one-time Medicare benefit

July 4, 2008

Our internal medicine practice gives yearly physicals to anyone who requests them, arranging for those whose insurance doesn't cover annual exams to self-pay. Recently, several older patients told us that Medicare now covers this preventive service?a change we're not aware of. Are they right?

Key Points

Our internal medicine practice gives yearly physicals to anyone who requests them, arranging for those whose insurance doesn't cover annual exams to self-pay. Recently, several older patients told us that Medicare now covers this preventive service-a change we're not aware of. Are they right?

Not exactly. Your patients may be referring to the Initial Preventive Physical Examination (IPPE), commonly known as the "Welcome to Medicare" exam. The IPPE was included in the 2003 Medicare Prescription Drug, Improvement, and Modernization Act. It took effect in January 2005, and many providers still aren't aware of its existence or the rules associated with the IPPE.

In fact, the exam is a once-in-a-lifetime benefit and must be performed within six months of Medicare Part B enrollment. Additionally, it must include the following seven components (1) review of medical and social history, with a focus on modifiable risk factors; (2) screening for depression; (3) review of functional ability and safety level; (4) focused physical exam; (5) an ECG; (6) counseling regarding any risk factors elicited during the exam; and (7) education about other preventive services offered by Medicare. To report these services, use the following codes: G0344 for the exam, and G0366, G0367, and G0368 for the ECG tracing, interpretation, and report.

The author, vice president of operations for Reed Medical Systems in Monroe, MI, has more than 30 years' experience as a practice management consultant, as well as being a certified coding specialist, certified compliance officer, and a certified medical assistant.