Gastroenterology Coding Alert

Question: The provider spent an hour discussing advanced care planning with a patient’s family member. Which codes can be used for optimal reimbursement?

Maine Subscriber

Answer: To report face-to-face service between a provider and a patient or his family member, such as counseling and discussing advanced care, you may report 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) for the first 30 minutes of advanced care planning. For reporting additional 30-minute blocks of care you may report add-on code 99498 (…each additional 30 minutes [List separately in addition to code for primary procedure]). This discussion may or may not include completing legal forms.