2005 Preventive Medicine Coding

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2005 Preventive Medicine Coding

• Steven A. Adams, CPC, CPC-H, COA

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2005Preventive Medicine Services
Nine out of ten people like chocolate. The tenth
person always lies.. --John Q. Tullius
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• Initial Preventive Physical Exam
• EKG
• Pelvic examination
• Pap - obtain
• Occult Blood
• Flu vaccine
• Pneumonia vaccine
• Hepatitis vaccine
• Colonoscopy patient at high risk

• G0344 100.84
• G0366 28.35
• G0101 39.09
• Q0091 42.14
• G0107 4.49
• G0008 18.66
• G0009 8.66
• G0010 8.66
• G0105 401.85

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• Colonoscopy screening exam
• Prostate exam
• DM self-management
• Bone Mass Measurement (DEXA)
• Mammogram
• Glaucoma screening
• Medical NT for DM/Renal
• Cardiovascular screening
• Diabetes screening

• G0121 401.85
• G0102 22.37
• G0108 34.18
• 76075 147.89
• 76092 89.93
• G0117 46.86
• 97802 19.50 15 min.
• 80061 18.72
• 82947 5.48

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Initial Preventive Physical Exam (IPPE)
Life is like a box of chocolates. You never know
what you're going to get. --Forrest Gump
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Initial Preventive Physical Exam
G0344 - 100.84
G0366 - 28.35

• Comprehensive Medical Social History
• Determine Potential Risk Factors/Depression
• Review Functional Ability and Level of Safety
• Must Examine Height, Weight, BP and Visual Acuity
• Examine Other Areas Deemed As Appropriate
• Perform an ECG
• Conduct necessary Education, Counseling
  Referrals as Appropriate

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Initial Preventive Physical Exam

• Pneumococcal, Influenza and Hepatitis Vaccine
• Screening Mammogram
• Prostate Screening
• Colorectal Cancer Screening
• Diabetes Outpatient Self-Management Training
• Bone Mass Measurement
• Glaucoma Screening
• Medical Nutrition Therapy Services
• Cardiovascular DM Screening Tests

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Initial Preventive Physical Exam

• Cannot be billed by Midwifes
• Can be billed by PA, NP, or CNS
• Cannot bill a prostate exam
• Medicare still to decide what to do about ECG
• No comment on billing a pap and/or pelvic at same
  time
• Following comment on split billing
• Can bill with a 99202 or 99212 if medically
  necessary

Only covered in first 6 months of Coverage
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Pap Pelvic Occult Blood
Will work for chocolate --Esther Schindler
www.gamedicare.com/policies/150.htm
www.gamedicare.com/provider/pap.htm
www.gamedicare.com/provider/pelv.htm
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Medicare Information
G0101 - 39.09

• G0101 - Breast and pelvic
• Q0091 - Pap smear
• G0107 - Occult Blood
• V76.51 CA screen of colon
• V76.2 CA screen of Cervix
• V76.47 CA screen of Vagina
• V76.49 Woman without Cervix
• V15.89 High risk Cervical CA

Q0091 - 42.14
G0107 - 4.49
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High Risk For Cervical CA

• Cervical Cancer High Risk Factors
• 1. Early onset of sexual activity (under 16
  years of age)
• 2. Multiple sexual partners (five or more in a
  lifetime)
• 3. History of a sexually transmitted disease
  (including HIV infection)
• 4. Fewer than three negative Pap smears within
  the previous seven years
• Vaginal Cancer High Risk Factors
• 1. DES (diethylstilbestrol)-exposed daughters of
  women who took DES during pregnancy

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Vaccines
It's not that chocolates are a substitute for
love. Love is a substitute for chocolate.
Chocolate is, let's face it, far more reliable
than a man. --Miranda Ingram
www.gamedicare.com/provider/immun.htm
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Vaccines
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Screening Flex Sigmoidoscopy Colonoscopy
What you see before you, my friend, is the result
of a lifetime of chocolate. --Katharine Hepburn

www.gamedicare.com/policies/L16878.htm
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Colonoscopy

• G0121 - 1 per 10 years
• Standard Screening
• 47 months following a screening flex
  Sigmoidoscopy
• G0104 - 131.99

• G0105 - 1 per 2 years
• High Risk
• Close relative with colon ca
• Family hx of adenomatous polyposis
• nonpolyposis colorectal ca
• Personal hx of
• adenomatous polyp
• colorectal cancer
• Inflammatory bowel dx

G0104 - 131.99
G0121 - 401.85
G0105 - 401.85
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Prostate Cancer Screening
Strength is the capacity to break a chocolate bar
into four pieces with your bare hands - and then
eat just one of the pieces --Judith Viorst
www.gamedicare.com/provider/PCS.htm
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Prostate Examination

• G0102 - Digital Rectal
• 1 every year - 50 or older
• Cant bill with EM code
• Can be billed by midwife?
• G0103 - PSA Test
• Billed by laboratory
• Remember this when patient calls to complain
  about lab bill

G0102 - 22.73
G0103 - 25.70
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Self Management for Diabetes
Not everything that can be counted counts, and
not everything that counts can be counted.
Albert Einstein
www.gamedicare.com/newspubs/Aug01/09.htm
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DSMT
G0108 - 34.15 (30 min)
G0109 - 19.90 (30 min.)
Can be requested by physician or NPP. Provider
must have a comprehensive signed plan in the
patients chart and explanation of why a patient
needs individual and not group training

• G0108
• Patient receives 10 hours of training the first
  continuos 12 month period.
• Nine hours must be in a group setting with 2-20
  people or a specific order from the doctor
  because groups not available or patient has
  specific needs.
• Patient gets 2 hours per year following the
  initial 12 month period.
• Has to meet either
• ADA certification or
• CMS accreditation

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DSMT

• New onset of Diabetes
• HBA1c level of 8.5 or more on two consecutive
  HBA1c tests 3 or months apart in the year before
  training
• Change in treatment regimen from diet control to
  oral diabetes medication or from oral to insulin
• High risk for complications based on inadequate
  glycemic control
• High risk on at least on of the following
• lack of feeling in the foot
• Pre- proliferative retinopathy
• Kidney complications

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Screening Mammograms
All I really need is love, but a little
chocolate now and then doesn't hurt! --Lucy Van
Pelt (in Peanuts, by Charles M. Schulz)
www.gamedicare.com/provider/mammography2.htm
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Screening Mammogram
76092 - 89.93

• V76.12
• 35-39
• Pts in this age group get one screening
  examination
• Over 39
• Patients over 39 are eligible for a screening
  mammogram on an annual bases.

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Bone Mass Measurements
There are four basic food groups, milk chocolate,
dark chocolate, white chocolate, and chocolate
truffles.
--Lisa Adams (the wife)
www.gamedicare.com/policies/121.htm
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Bone Mass Measurement
76075 - 147.89
76076 - 44.38

• Every 1 year if
• Monitoring patient on long-term glucocorticoid
  therapy of more than 3 months or
• Other Medical Necessary services must have
  supporting documentation filed with the service.
• Every 2 years if
• Women who is estrogen deficient and at risk for
  osteoporosis
• Individual with vertebral abnormalities - per
  x-ray
• Person receiving glucocorticoi therapy
• Individual with hyperparathyroidism
• Person being monitored for an FDA approved
  osteoporosis drug therapy

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Glaucoma Screening

• Chemically speaking, chocolate really is the
  world's perfect food. --Michael Levine

www.gamedicare.com/newspubs/dec01/08.htm
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Glaucoma Screening

• G0117 - Physician
• 1 every year
• Pt Has Diabetes Mellitus
• Has Family Hx of Glaucoma
• V80.1
• G0118 - Physician Directed
• See Above

G0117 - 46.86
G0118 - 28.43
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Medical Nutrition Therapy

• I never met a chocolate I didn't like. --Deanna
  Troi in Star Trek

www.gamedicare.com/newspubs/sept02/16.htm
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MNT
97802 - 19.50
97803 - 19.50
Only payable for a registered dietitian or
nutrition professionals that meet specific
requirements - see policy

• 97802
• Initial visit for an assessment for patients with
  diabetes or renal disease
• Can only be referred by a physician - no NPPs
• First visit up to 3 hours only
• Cannot do DMST and MNT on same day
• 97803
• This code is used for all individual
  reassessments and all interventions after the
  initial visit.

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Cardiovascular DM Screening Tests
Other things are just food. But chocolate's
chocolate. --Patrick Skene Catling
www.gamedicare.com/provider/pelv.htm
www.gamedicare.com/provider/pelv.htm
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ScreeningLabs
82947 - 5.48
80061 - 18.72

• Cardiovascular Screening (80061) - V81.0, V81.1,
  V81.2
• One screening test ever 5 years
• If patient wants more, have them sign the ABN
• ABN should indicate Medicare will likely deny
• Diabetic Screening (82947) - V77.1
• Two screenings per 12-month period
• At risk HTN, Dyslipidemia, Obesity, Elevated
  fasting glucose, Several risk factors (see policy)

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Home Health Hospice
Don't wreck a sublime chocolate experience by
feeling guilty. Chocolate isn't like premarital
sex. It will not make you pregnant. And it always
feels good. --Lora Brody
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Medicare Information

• G0179 - Home Health Recertification
• G0180 - Home Health Certification
• G0181 Home Health Agency 30 Min
• G0182 Hospice Care 30 Minutes

G0179 - 59.85
G0180 - 77.98
G0181 - 128.89
G0182 - 136.21
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How Do I Remember All This Stuff?
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You Cant
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Remember
If it aint chocolate, it aint breakfast...
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• Questions?