2005 Preventive Medicine Coding

1. Steven A. Adams, CPC, CPC-H, COA 2005 Preventive Medicine Coding

2. 9 2005Preventive Medicine Services Optimism is essential to achievement and it is also the foundation of courage and true progress. Nicholas Murray Butler

3. Initial Preventive Physical Exam EKG Pelvic examination Pap - obtain Occult Blood Flu vaccine Pneumonia vaccine Hepatitis vaccine Colonoscopy patient at high risk Colonoscopy screening exam Prostate exam DM self-management Bone Mass Measurement (DEXA) Mammogram Glaucoma screening Medical Nutrition Therapy for DM/Renal Cardiovascular screening Diabetes screening 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 G0121 $401.85 G0102 $ 22.37 G0108 $ 34.18 76075 $147.89 76092 $ 89.93 G0117 $ 46.86 97802 $ 19.50 - per 15 min. 80061 $ 18.72 82947 $ 5.48

4. 13 14 Initial Preventive Physical Exam (IPPE) There are liars, damn liars, and statistics. Mark Twain www.gamedicare.com/provider/InitialPreventiveExams.htm

5. 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

6. 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

7. 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 99201-99205 (-25) if medically necessary Only covered in first 6 months of Coverage

8. Pap & Pelvic & Occult Blood I haven’t failed, I’ve found 10,000 ways that don’t work. Thomas Edison www.gamedicare.com/policies/150.htm www.gamedicare.com/provider/pap.htm www.gamedicare.com/provider/pelv.htm

9. 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 6 Medicare Information G0101 - $39.09 Q0091 - $42.14 G0107 - $ 4.49

10. 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

11. Vaccines I don’t know the key to success, but the key to failure is trying to please everybody. Bill Cosby www.gamedicare.com/provider/immun.htm

12. Vaccines

13. Screening Flex Sigmoidoscopy & Colonoscopy Government, even in its best state, is but a necessary evil; in its worst state, an intolerable one. Thomas Paine www.gamedicare.com/policies/L16878.htm

14. 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 Colonoscopy G0104 - $131.99 G0121 - $401.85 G0105 - $401.85

15. Prostate Cancer Screening He who can, does - he who cannot, teaches. George Bernard Shaw www.gamedicare.com/provider/PCS.htm

16. Prostate Examination • G0102 - Digital Rectal • 1 every year - 50 or older • Can’t bill with E&M 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

17. 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

18. 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 patient’s 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

19. 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

20. Screening Mammograms Always be nice to your children because they are the ones who will choose your rest home. Phyllis Diller www.gamedicare.com/provider/mammography2.htm

21. Screening Mammogram 76092 - $89.93 • V76.12 • 35-39 • Pt’s in this age group get one screening examination • Over 39: • Patients over 39 are eligible for a screening mammogram on an annual bases.

22. Bone Mass Measurements • I will permit no man to narrow and degrade my soul by making me hate him. Booker T. Washington www.gamedicare.com/policies/121.htm

23. 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

24. To be successful, a woman has to be much better at her job than a man. Golda Meir Glaucoma Screening www.gamedicare.com/newspubs/dec01/08.htm

25. 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

26. Hide not your talents. They for use were made. What's a sundial in the shade. Ben Franklin Medical Nutrition Therapy www.gamedicare.com/newspubs/sept02/16.htm

27. 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.

28. Cardiovascular & DM Screening Tests I don't care what people think. people are stupid.--Charles Barkley www.gamedicare.com/provider/pelv.htm www.gamedicare.com/provider/pelv.htm

29. 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)

30. Home Health & Hospice Fear is a disease that eats away at logic and makes man inhuman. --Marian Anderson

31. G0179 - Home Health Recertification G0180 - Home Health Certification G0181 – Home Health Agency – >30 Min G0182 – Hospice Care – >30 Minutes Medicare Information 07 08 G0179 - $59.85 G0180 - $77.98 G0181 - $128.89 G0182 - $136.21

32. How Do I Remember All This Stuff?

33. You Can’t

34. Remember: If all else fails, destroy the evidence and blame your mistakes on someone else. OJ Simpson, Martha Stewart, Scott Peterson, Your Ex-Wife, Enron, Haliburton, CBS - Dan Rather Richard M. Nixon, Bill Clinton, George W. Bush, John F.Kerry Your Office Manager, The Yankees Steve Adams

35. Questions?