EM Coding Alert

Question: What ICD-10 codes can I report with 99497 and +99498? I’ve heard that we can use HCPCS code S0257 or Z02.89 for non-Medicare patients.

North Carolina Subscriber

Answer: You report advance care planning (ACP) with 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 [List separately in addition to code for primary procedure])

While you won’t find any diagnosis requirements for 99497 and +99498, you could report the chronic condition that initiated the ACP, according to Najwa N. Liscombe, BHSA, CPC-CPC-I, CMA , coding reimbursement analyst III at the University of Florida College of Medicine and Community Health and Family Medicine in Gainesville, Florida.

Maggie M. Mac, CPC, CEMC, CHC, CMM, ICCE, AHIMA-approved ICD-10 CM/PCS trainer and president of Maggie Mac-Medical Practice Consulting in Clearwater, Florida, agrees that you will probably use the diagnosis of whatever chronic illness the patient has.

“If you do ACP in conjunction with the annual wellness visit, then it’s probably going to follow with the diagnoses of the annual wellness visit,” Mac adds.

According to JoAnne Sheehan, CPC, CPB, CPPM, COC, CPC-I senior instructor/coach at Certification Coaching Organization, LLC in Oceanville, New Jersey, you should link diagnoses to the ACP supporting the need for ACP, if applicable, or use a preventive diagnosis code with the preventive visit.