The two new advanced care planning codes (99497 and 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 99497 to be billed for the first 30 minutes, and 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 (99201-99215),
- observation initial, subsequent and discharge care codes (99217-99220, 99224-99226),
- initial, subsequent and discharge hospital service codes (99221-99233, 99238-99239),
- observation or inpatient admit and discharge on the same date (99234-99236),
- outpatient and inpatient consultations (99241-99255),
- emergency department visit codes (99281-99285),
- initial, subsequent and discharge nursing facility care codes (99304-99316),
- annual nursing facility assessment code (99318),
- new, established and discharge domiciliary or rest home visit codes (99234-99337),
- new and established patient home visit codes (99341-99350),
- initial and periodic preventive medicine codes (99381-99397), and
- Transitional Care Management Service codes (99495-99496)
However, these codes cannot be billed with
- critical care codes (99291, 99292),
- inpatient neonatal and pediatric critical care codes (99468-99476), or
- initial and continuing intensive care services (99477-99480).
Medicare has indicated that it will NOT pay for codes 99497 or 99498 in 2015.
- Reference: www.medicaleconomics.modernmedicine.com