The two new advanced care planning codes (CPT 99497 and CPT 99498) are used to report the face-to-face service between a physician or other qualified healthcare professional (QHCP) and a patient, family member, or surrogate in counseling and discussing advance directives, with or without completing relevant legal forms.
As you can see, a face-to-face visit is required but doesn’t have to include the patient. The CPT manual defines an advanced directive as, “A document appointing an agent and/or recording the wishes of a patient pertaining to his/her medical treatment at a future time should he/she lack decisional capacity at that time.”
These are time-based codes, with CPT 99497 to be billed for the first 30 minutes, and CPT 99498 for each additional 30 minutes. Because the purpose of the visit is the discussion, no active management of the patient’s problem(s) is performed during the time of these visits.
Additionally, these code(s) can be billed in for the following E/M services:
- new and established patient office visits (CPT 99201 – CPT 99215),
- observation initial, subsequent and discharge care codes (CPT 99217 – CPT 99220, CPT 99224 – CPT 99226),
- initial, subsequent and discharge hospital service codes (CPT 99221 – CPT 99233, CPT 99238 – CPT 99239),
- observation or inpatient admit and discharge on the same date (CPT 99234 – CPT 99236),
- outpatient and inpatient consultations (CPT 99241 – CPT 99255),
- emergency department visit codes (CPT 99281 – CPT 99285),
- initial, subsequent and discharge nursing facility care codes (CPT 99304 – CPT 99316),
- annual nursing facility assessment code (CPT 99318),
- new, established and discharge domiciliary or rest home visit codes (CPT 99234 – CPT 99337),
- new and established patient home visit codes (CPT 99341 – CPT 99350),
- initial and periodic preventive medicine codes (CPT 99381 – CPT 99397), and
- Transitional Care Management Service codes (CPT 99495 – CPT 99496)
However, these codes cannot be billed with
- critical care codes (CPT 99291, CPT 99292),
- inpatient neonatal and pediatric critical care codes (CPT 99468 – CPT 99476), or
- initial and continuing intensive care services (CPT 99477 – CPT 99480).
Medicare has indicated that it will NOT pay for codes CPT 99497 or CPT 99498 in 2015.
- Reference: www.medicaleconomics.modernmedicine.com