To the Editor:

I was hoping you might have more information on how to coordinate the billing of an electrocardiogram (ECG) with the Medicare initial preventive physical exam (IPPE) [“How to Conduct a ‘Welcome to Medicare’ Visit,” April 2005, page 27]. Do you need to wait to submit the claim for the IPPE until the ECG is in the chart?

Editor's response:

According to Cynthia Hughes, CPC, coding and compliance specialist for the AAFP, all elements of the IPPE – including the ECG – must be performed before the IPPE is billed. She checked with the Centers for Medicare & Medicaid Services and received this clarification: “We encourage physicians to ensure the ECG has been performed before submitting a claim for an IPPE. Post-pay audits may be conducted to determine if claims paid for the IPPE were paid appropriately.”

If your practice won't be performing ECGs on site, Hughes recommends scheduling patients' ECGs to occur prior to the IPPE. This will allow the physician who performs the IPPE to have the ECG result and discuss it with the patient at the time of the IPPE. However you choose to handle the ECG, confirmation that the ECG has been performed must be obtained and the patient chart should include a note to that effect prior to billing Medicare for the IPPE.