The initial preventive physical exam (IPPE) is an important service for every family physician’s office, so be sure to report it appropriately. Know the criteria IPPE visits must meet and when to use G0402, straight from a recent CMS National Provider Call.
Learn the IPPE Basics
“The IPPE is a one-time visit and is covered for beneficiaries within the first 12 months of Medicare Part B enrollment,” says Jamie Hermansen, a health insurance specialist with CMS’s Office of Clinical Standards and Quality/Coverage and Analysis Group. “The IPPE is covered by Medicare Part B.”
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A variety of professionals can furnish the IPPE, including:
- Physician assistant
- Nurse practitioner
- Clinical nurse specialist.
Remember: The IPPE is a dedicated preventive visit, not an exam addressing specific problems.
“The IPPE is not a head-to-toe physical examination,” points out Stephanie Frilling with the Division of Practitioner Services for the Hospital and Ambulatory Policy Group (HAPG). “While there is some overlap, the focus of the IPPE is to furnish education, counseling, and prevention services appropriate for the individual and available in Medicare.”
Apply the Correct Codes
A single code applies to the IPPE itself: G0402 (Initial preventive physical examination; face-to-face visit, services limited to new beneficiary during the first 12 months of Medicare enrollment).
Include any appropriate diagnosis to help justify the visit.
“Although a diagnosis code must be reported on the claim, there are no specific ICD-9 diagnosis codes that are required...
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