Forum - Questions & Answers

Jul 13th, 2009 - AWIKSTROM 1 

Welcome to Medicare Physical

my doctor seems to think that we can bill for numerous other screenings at the time of this visit. 94010, 94375, 85025, 80053, 84443, 84153, 82274. I tried using a modifier 25 with G0402 and have gotten denied "procedure code inconsistent with modifier used or modifier is missing" does this not need a modifier? Its been awhile since I did Welcome to Medicare and I can't remember the rules.

Thanks
Ann

Jul 13th, 2009 - nmaguire   2,606 

welcome to medicare exam

The Welcome to Medicare visit is a comprehensive examination consisting of the following 7 components:
1. A review of an individual's medical and social history with attention to modifiable risk factors
2. A review of an individual's potential risk factors for depression
3. A review of the individual's functional ability and level of safety
4. A physical examination to include an individual's height, weight, blood pressure, visual acuity, and measurement of body mass index (a new requirement effective Jan. 1, 2009)
5. End-of-life planning (a new requirement effective Jan. 1, 2009)
6. Education, counseling, and referral based on the results of the review and evaluation services described in the previous five components
7. Education, counseling, and referral, including a brief written plan such as a checklist for obtaining the appropriate screening and/or other Medicare Part B preventive services

*Performance of an electrocardiogram (EKG) and interpretation of the EKG is no longer required as part of this service.

Note: The reimbursement for this benefit does not include any clinical laboratory tests.

Jul 13th, 2009 -

No test covered

You can do all that other stuff but you must have a valid diagnosis- COPD, HTN, etc. The Welcome to Medicare exam is the history, the exam, the EKG, an AAA screening ultrasound and advice to get a colonoscopy. Here is Medicare's quick reference sheet- 2 pages of help: http://tinyurl.com/m2og7a

Jul 13th, 2009 - Codapedia Editor 1,399 

Welcome to Medicare Visit

There is an article in the data base that covers the Welcome to Medicare visit: search "Welcome to Medicare" in the search box, above "look it up" and you'll find it.

Also, you can find the CMS chart that shows the covered *screening* services, and their frequency in the article on "Preventive Medicine Services for Medicare Patients." Search on Preventive Medicine Service," and you'll find it. You can download the CMS reference, updated in early Jan. 2009.



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