Pulmonology Coding Alert

Question: Is it possible to bill for an E/M service along with an advance care planning meeting on the same date?

Maine Subscriber

Answer: Yes, you may be able to do that if the documentation supports each service. Suppose you get a patient with compensated congested heart failure, on medications. You will first provide evaluation and management service for her disease affliction, including revising her medications as appropriate. You may report 99204 (Office or other outpatient visit for the evaluation and management of a new patient, which requires these 3 key components: a comprehensive history; a comprehensive examination; medical decision making of moderate complexity. Counseling and/or coordination of care with other physicians, other qualified health care professionals, or agencies are provided consistent with the nature of the problem[s] and the patient’s and/or family’s needs. Usually, the presenting problem[s] are of moderate to high severity. Typically, 45 minutes are spent face-to-face with the patient and/or family) or 99205 (… 60 minutes…), depending on the time spent.

Then, in case the patient wishes to discuss long term options such as a heart transplant, you apprise the patient of the options available, and also discuss advance care planning, for treatment as per patient preferences, in case of a future health event that may affect her decision making capacity at that point of time. The advance care planning codes are 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 ...).

Documentation would need to be clear about the advance care planning discussion (separate from the management of other issues/options), and include the time.