2005 Preventive Medicine Coding

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

2. 2005Preventive Medicine Services Nine out of ten people like chocolate. The tenth person always lies.. --John Q. Tullius

3. 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

4. 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

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

6. 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

7. 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

8. 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

9. 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

10. 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 Medicare Information G0101 - $39.09 Q0091 - $42.14 G0107 - $ 4.49

11. 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

12. 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

13. Vaccines

14. 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

15. 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

16. 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

17. 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

18. 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

19. 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

20. 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

21. 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

22. 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.

23. 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

24. 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

25. Chemically speaking, chocolate really is the world's perfect food. --Michael Levine Glaucoma Screening www.gamedicare.com/newspubs/dec01/08.htm

26. 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

27. I never met a chocolate I didn't like. --Deanna Troi in Star Trek: Medical Nutrition Therapy www.gamedicare.com/newspubs/sept02/16.htm

28. 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.

29. 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

30. 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)

31. 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

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

33. How Do I Remember All This Stuff?

34. You Can’t

35. Remember: If it ain’t chocolate, it ain’t breakfast...

36. Questions?