Oncology & Hematology Coding Alert

Question: Our physician spent time discussing end of life planning as a part of advance care of the patient. In 2015, we have code 99497 and +99498 for this service. Can you confirm what documentation we need for this billing these codes? Can we submit advance care code 99497 for a Medicare patient?

New York Subscriber

Answer: The two advance care planning CPT® codes introduced in this year include: 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 any 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/or +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: The 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 rule making 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 to these codes.

Reference: Refer to www.tinyurl.com/pl7yeuo to read the entire Federal Register article.