Advance Care Planning- 99497

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Hello All!

I have a Palliative medicine provider that is billing 99497 very frequently with subsequent hospital visits. I did a quick audit of the documentation and am wondering is anyone can help with some clarification on this code. Almost all of the patient's that he is billing this code with are at the end of life. He is documenting the conversation with the family, and when he can, the patient (many of them are on vent or unconscious). In some cases he is billing this code on subsequent days. He will document the full conversation with the family and there is never a change in the plan or goals of care. Either patient wishes to remain on support or id DNR. The time that the physician documents is not specific to advance care planning. In general he will state "time spent in counseling/coordination of care/with patient: 25 minutes" (or fill in what ever time).

I don't see this is advance care planning as stated by Medicare guidelines that I have seen. Does anyone else have any input on these codes?? Is advace care planning generally done in the office? how often is this done in the hospital setting at the patient's bedside? Should the physician document time spent specific to ACP??
Thank you for any information!
 
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Advanced Care Planning

Providers are funny when interpreting coding guidelines. I am a Coding Educator and spend much of my time trying to figure out what the provider did and what they intended with billing/documentation, creating education on the documentation required to back up the provider's intention and educating on appropriateness of the intention. We walk a fine line when educating providers on proper documentation, it must be coupled with actions that truly happened.

In the case as you have described it, I would be wary of providers trying to capture this code without documentation to provide the backup. I have seen inpatient cases in which the patient is under Q-life care and all providers on the case are trying to capture the 99497 code. If a provider does complete the documentation for the Advanced Directive with the patient, they should capture the code appropriately. If other providers counseled additionally, for at least 16 minutes, then they too can capture the code. It is possible each provider is quizzed about the Q-life status and counseling is truly provided, however just because a patient is Q-life does not mean that every conversation is worthy of capturing the code. Most of the conversations will be about the end of life.

Not sure if this helps, but one can hope.

VJ
 
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