Part B Insider (Multispecialty) Coding Alert

Published on Mon Oct 20, 2014 PDF

Question: I saw that CPT® 2015 includes advance care planning codes. Can you explain how we’ll report those? 

Answer: 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.” 

Typically, the patient’s primary care provider will handle advance care planning for the patient, although CMS has not yet clarified who will be able to report them and who won’t.

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. Keep an eye on the Insider for more on whether this service will be payable, which will be determined after CMS releases the 2015 Physician Fee Schedule.