Wiki Reporting CPT 99497 or 99498 for Advance Care Planning

[amwittler]

From what I can find Advance Care Planning can be reported with a Medicare Annual Wellness Visit. Medicare states that the billing physician or qualified provider must participate and meaningfully contribute to the provision of the Advance Care planning, in addition to providing a minimum of direct supervision. What exactly does this mean? Is it enough for the provider to briefly review the HCPOA and/or POLST Form with patient then document that they did in addition to the documentation provided by an RN who is performing the Medicare Annual Wellness Visit.

 

[jkyles]

Hello there, the treating provider must perform at least 16 minutes of service strictly related to the ACP to report one unit of 99497 (it is a time-based primary/add-on code set). Reviewing a specific form or forms with the patient is not required to report this code but might be part of the encounter. This guide from CMS gives more information on what is required https://www.cms.gov/outreach-and-ed...mlnproducts/downloads/advancecareplanning.pdf

 

[amwittler]

Hello there, the treating provider must perform at least 16 minutes of service strictly related to the ACP to report one unit of 99497 (it is a time-based primary/add-on code set). Reviewing a specific form or forms with the patient is not required to report this code but might be part of the encounter. This guide from CMS gives more information on what is required https://www.cms.gov/outreach-and-ed...mlnproducts/downloads/advancecareplanning.pdf

So the minutes cannot include the time the nurse is spending with the patient too?

 

[jkyles]

Sorry, to clarify: It sounds like clinical staff perform most of the work for the ACP service (which is separate from the AWV) and the billing provider spends a couple of minutes on follow up? If so, no because that I don't think that the provider's work/time can meet the meaningfully contribute requirement. https://www.cms.gov/medicare/medica...sched/downloads/faq-advance-care-planning.pdf. But your documentation might tell a different story.

The ACP services described by these codes are primarily the provenance of patients and physicians; accordingly we expect the billing physician or NPP to manage, participate and meaningfully contribute to the provision of the services in addition to providing a minimum of direct supervision.

 

[rachaelwilleford]

So the minutes cannot include the time the nurse is spending with the patient too?

No, ACP is a discussion between a physician/QHP and the patient, family, caregiver, or surrogate.