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New vs. established: How to bill a new patient for IPPE, E/M in same encounter

Question: A new patient comes for his Welcome to Medicare visit and a medical problem. This is his first time at the office. Do we bill “new patient” for the Initial Preventive Physical Exam (IPPE) and “established patient” for the E/M? Are there any circumstances under which a patient may go from new to established in the same encounter?

Answer: You can report both the IPPE and E/M in the same encounter, says Andria Jacobs, chief operating officer of PCG Software in Las Vegas. The Medicare Claims Processing Manual says you can do that with a Welcome to Medicare visit (aka IPPE) and even with an annual wellness visit (AWV). Just use Modifier 25 (Significant, separately identifiable E/M services) with the E/M claim. Remember, though — if elements of the history and exam portion of the IPPE or AWV impact the E/M, the manual says you can’t use them in determining the E/M level.

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