Urology Coding Alert

Pay attention to time documentation for correct use. 

If your urologist does advance care planning for patients, you will likely make use of two new codes that CPT® added for 2015. Read on to learn about the new additions and the lingering questions experts have about how you’ll use these codes. 

Add 99497-99498 to Your Coding Arsenal

CPT® 2015 adds two new advance care planning 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 add-on code +99498 (... each additional 30 minutes ....).

According to CPT® 2015, you’ll use 99497 and +99498 to report a face-to-face service between a “physician or other health care professional and a patient, family member, or surrogate in counseling and discussing advance directives, with or without completing relevant legal forms.” Note that the CPT® notes for reporting 99497 and +99498 state that “no active management of the problem(s) is undertaken during the time period reported.” 

Experts say that urologists won’t often use 99497 and +99498 as it is more likely by the patient’s primary care provider will handle advance care planning for the patient.

“I think these codes will be confusing to the providers,” says Suzan Berman (Hauptman), MPM, CPC, CEMC, CEDC, director of coding operations-HIM at Allegheny Health Network in Pittsburgh, Pa. “Without a directive on who can do it, how it needs to be documented, etc., I fear these will either not be used or will be misused.” 

Payment questions: Remember that just because you have a new code for a service, that doesn’t guarantee you will get paid for that service. “Just because there is a code, doesn’t mean there’s a reimbursement,” Berman says. “The fact that this could take place without the patient, I’m concerned that   the face-to-face component not being there in all cases might negate the service as not reimbursable.”

Note: Urology Coding Alert Vol. 16, No. 11 listed +99498 as a chronic care management (CCM) code under parent code 99490 (Chronic care management services, at least 20 minutes of clinical staff time directed by a physician or other qualified health care professional, per calendar month, with the following required elements…). However, +99498 comes after and relates to parent code 99497 as noted in this article. Code 99490 appears out of numerical sequence in the CPT® 2015 manual.