By: Christine Smidt, BA, CPC, CRC, Risk Adjustment & Quality Specialist, CHPA
How to best prepare:
- Have patient complete questionnaires prior to arrival regarding past medical history, medications/supplements, depression screening, opioid and substance abuse screenings and ADL’s.
- Have staff provide forms for patient to complete at home prior to appointment, ideally this would be done when the IPPE/AWV is scheduled.
- Review other providers and specialties patient’s sees including Behavioral Health providers
- Have patient bring in all medications and supplements.
- Consider the best way to communicate with underserved populations, people with limited English proficiency, health literacy needs, and persons with disabilities.
You must report a diagnosis code when submitting an IPPE claim. Medicare does not require you to document a specific diagnosis code, so you may choose any diagnosis code consistent with the patient’s exam. Typically, a screening or preventive code is used however chronic conditions that were addressed at this time should also be included as well.
AWV’s and IPPE’s can be performed a physician, either MD or DO, or a non-physician Practitioner (NPP) such as a Physician Assistant [PA], Nurse Practitioner [NP], or Certified Clinical Nurse Specialist [CCNS].
Due to the PHE, Medicare is allowing IPPE/AWV’s to be done via telehealth. The only limitation to this would be the inability to collect vitals. Adding modifier -GT
Components of the IPPE (Welcome to Medicare) Visit:
- Reviewing past medical, family & social history
- Includes surgeries, hospitalizations, injuries
- Medications and supplements
- Diet/Physical activities
- Reviewing potential depression risk factors
- Standardized screening tools are used to screen patients for depression and anxiety (PHQ 9)
- Reviewing patient’s functional abilities
- Ability to perform Activities of Daily Living (ADL’s) (showering, meal prep)
- Fall risk (rugs on floors, handlebars in showers)
- Hearing impairments
- Other home safety
- Examination
- Height, weight, BMI, waist circumference (if appropriate), and blood pressure
- Visual acuity screening
- Other factors deemed appropriate based on above
- End of Life Planning
- Verbal or written information given to the patient regarding Advanced Directives, 5 Wishes
- Advance Care Planning (CPT 99497, 99498)
- Advance care planning including the explanation and discussion of advance directives such as standard forms (with completion of such forms), by the physician or other qualified health care professional; 30 minutes, face-to-face with the patient, family member(s), and/or representative
- Reviewing opioid prescriptions
- Screening for Opioid Use Disorder risks (overdose history, other substance use/abuse disorders, high opioid doses)
- Making needed referrals to pain management or changing prescriptions to non-opioid treatments
- Reviewing for Substance Abuse Disorders
- Other preventive services
- Once in a lifetime EKG (CPT G0403/G0404/G0405)
- Establish an appropriate written screening schedule for patients, such as a checklist for next 5–10 years
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