Cardiology Coding Alert

If you counsel patients on health care proxy issues, check payer coverage.

Advance care planning is a reality of the healthcare business, and CPT® acknowledged this with two new codes. CMS has opted to hold off on considering them valid for coverage, but other payers may take a different approach. 

Read what experts have to say about the new codes to gain confidence and ensure you use them successfully.

Meet the New Codes on the Block

New this year are two advance care planning CPT® codes: 99497 (Advance care planning including the explanation and discussion of advance directives such as standard forms [with completion of such forms, when performed], by the physician or other qualified health care professional; first 30 minutes, face-to-face with the patient, family member[s], and/or surrogate) and +99498 (…each additional 30 minutes).

You can use these two new codes when the following are a part of the physician service:

• Face-to-face visit between a physician or qualified healthcare professional and family members or representatives

• Counseling and discussing advance directives

• Filling out related legal forms.

Definition: An advance directive is a legal document designating an agent that represents the patient and contains the written wishes of the patient for his treatment if he is unable to communicate said wishes. An example of an advance directive might be a power of attorney form or health care proxy.

Reminder: You report 99497 and +99498 for the period of time that advance care planning takes place. There’s no problem management during this time.

Learn What You Need to Look for in the Documentation

There is little direction available on the two new advance care planning codes but there are expectations for the physician note.

“Advance care planning is part of many discussions with patients, but the requirements to properly bill 99497 and +99498 are more significant,” says Janean Walker, CPC, CEMC, a consultant at Medical Revenue Solutions in Grain Valley, Mo. “Training physicians how to have advance care planning conversations about end of life and what needs to be documented may be the biggest hurdle.” The recommended documentation should include the following:

• Evaluation to determine patient risk, benefits, and alternatives

• Forms

• Discussion of patient’s beliefs, values, and goals

• Discussion of care options

• Time spent discussing.

Recognize Current Billing Status

CMS is waiting until they go through notice and comment rulemaking to decide whether to pay for advance care planning services. According to the Nov. 13, 2014, Federal Register, the two codes have a physician fee schedule (PFS) status indicator of “I,” meaning Medicare is not recognizing these two codes for these services in 2015. No dollar amount has been associated with these codes.

“I would suggest checking with commercial carriers; they may be willing to reimburse for the code and service,” says Joann Baker, CCS, CPC, CPC-H, owner of Precision Coding and Compliance, LLC in Hackettstown, N.J. “You may also be able to use regular E/M; however, as always, check with the payer.”