Urology 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 specific diagnostic requirements for 99497 and +99498, you could report the chronic condition(s) 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. Other coding experts agree, adding that you should link diagnoses to the ACP supporting the need for ACP, if applicable, or use a preventive diagnosis code with the preventive visit.

Plus: You may also report HCPCS code S0257 (Counseling and discussion regarding advanced directives or end of life care planning and decisions, with patient and/or surrogate [list separately in addition to code for appropriate E/M service]) for private and non-Medicare insurers.