Q1: We get confused about the various Medicare Preventive visits. The IPPE and initial wellness visits list depression screening (G0444) & alcohol screening (G0442) in the CMS documents online, but doesn’t CMS forbid the use of these codes during welcome to Medicare and initial wellness visits?
A1: There are several documents on the CMS website outlining the IPPE and AWV service and the required components of those. Some just list all the potential ‘Other Medicare Part B Preventive Services’, but you are correct about the G0444, that is bundled into both the G0402 and the G0438.
You can bill G0444 with a G0439, the subsequent AWV, which does not list depression screening as a required element.
But none of the AWVs or the IPPE specifically name alcohol screening or counseling- and neither the G0442 or the G0443 is currently bundled with these codes.in the NCCI, suggesting that they can be billed along with the G0402. G0438 and G0439. The IPPE does mentions under the 'Review the patient's History' - alcohol history, along with tobacco and other drugs, but that’s not the same as ‘counseling'.
However, the HRA, which is required for the G0438 and G0439, includes a review of Psychosocial and Behavioral risks - which would surely include alcohol. And the questions in the standard HRA are enough to 'score' a patient's risk. If taken out of the HRA - and set up as a discrete screening section in the chart - with some actual detail and of course time documented - this could support a G0442 in addition to any of these codes.
You would likely only do this with patients that scored positive - and not make this a 'routine' part of IPPE's or AWVs.
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