# LOOKING FOR MORE ADVICE-e/m coding for end of life care



## misstigris (Jan 14, 2010)

I am posting this again in hopes of getting more ideas and responses.. 

Needing some help in coding this scenario...

Patient comes in to see physician to discuss end of life planning. Patient is healthy, but wants to plan ahead and has discussion with physician about filling out advance directive and POLST forms. 

What CPT and ICD-9 codes would you use?

I have tried billing 99213 w/ V65.49 (but was denied)

--I ran across this code
HCPCS code S0257- but not sure when to use.

It has been suggested to use V66.7, but this code does not seem appropriate as pt is not sick..

Any ideas would be greatly appreciated.
Thanks 

I did get this response.. any other ideas out there???
----I would probably go with 99429 the unlisted preventive medicine service. For a dx I would use V65.8.


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## LLovett (Jan 15, 2010)

Well for a dx I would go with V68.89 Encounter for administrative purposes Other specified administrative purpose Other.

As far as cpt I am mostly in favor of the unlisted preventive. The only other option I see (besides the S code) would be that of 99401-99404. Which part of me is leary of because it is for behavior modification/risk factor reduction but it could be argued that is exactly what you are doing for a possible future problem. 

Oh, one other thing, Medicare has this as a PQRI code, which is not a reimbursable code. That makes me think that this is something that should be part of another service not a stand alone in their minds so I would be very hesitant to bill this to Medicare as a stand alone service. Just an additional thought.


I love it when things are clear as mud, makes the day so much more fun...lol

Laura, CPC, CPMA, CEMC


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## FTessaBartels (Jan 15, 2010)

*UNlisted preventive*

I think Unlisted Preventive visit CPT 99429 is the way to go here. 

I doubt that any insurance carrier will pay for this service, so be sure you have an ABN (or equivalent) signed.

Hope that helps.

F Tessa Bartels, CPC, CEMC


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## misstigris (Jan 18, 2010)

any other ideas S0257 vs. 99429? There was no ABN ( or equivalent) waiver signed-so not sure if we can hold pt responsible for cost of this service..


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## hthompson (Jan 18, 2010)

When this came up for me, my response wasn't nearly as kind when I questioned being able to bill for a visit re: Advanced Directives.  Lucky for me, it's not coming up in my office like I thought it would.  The MDs are only dealing with those forms when the patient comes in for something else, so I don't even code it.  The MD does their own documentation for patient care and I only code the problem which caused the visit.  Good to see that your responses are nice


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