Use an Additional Code for ACP Conversation
Question: My provider is conducting conversations about advance care planning (ACP) during annual wellness visits (AWV) for Medicare beneficiaries when they’re open to the discussion. What’s the best code to use to reflect the time spent on these conversations? Virginia Subscriber Answer: The Centers for Medicare & Medicaid Services (CMS) says that providers can report an additional CPT® code if they spend face-to-face time conversing with a patient about planning advance care options in case they become incapacitated or otherwise unable to communicate or make decisions about their care. CMS says that providers or their coders/billers should report a diagnosis code — any consistent with the patient’s exam — on the ACP claim as an optional element of an AWV. The two appropriate CPT® 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 (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; each additional 30 minutes (List separately in addition to code for primary procedure)). When billing, know that CMS will waive Part B ACP coinsurance and deductibles as long as: the ACP is provided on the same claim as the covered AWV, reflecting that the conversation occurred on the same day and by the same provider as the covered AWV; and is appended with modifier 33 (Preventive service). If the AWV has exceeded the once-per-year-limit, the deductible and coinsurance will apply for the ACP. Additionally, if the provider has a conversation about ACP with a patient beyond the covered AWV, the coinsurance and deductible apply; there are no limits on how many times one can bill for ACP services for a patient, as long as the provider documents the changes in the patient’s health status or end-of-care plans or wishes. Rachel Dorrell, MA, MS, CPC-A, CPPM, Development Editor, AAPC
