Wiki Advance Care Planning (99497)

[janetrose]

Has anyone else experienced this? All of the Medicare advantage plans require Advance care planning reported with 99497 but this code requries a minimum of 16 minutes time spent. If the discussion only takes 10 minutes, then it is not appropriate to report 99497 yet our ACO is telling us it must be reported to satisfy the care gap. What should we do? Everything i read says that if 15 minutes or less is spent we should just reflect that in the E&M code.

 

[jkyles]

Hi there, has someone explained this code and its requirements to your ACO's rep? https://www.cms.gov/outreach-and-ed...mlnproducts/downloads/advancecareplanning.pdf

In addition to the problem with reporting a service that doesn't meet the code's requirements, it sounds like they're saying it's a requirement for all patients? The service is voluntary on the patient's part, so what happens when a patient doesn't want to discuss it at all? Sorry I have so many questions in response to your question but I'm not clear on what's going on here.

 

[janetrose]

So to clarify, if the patient is open to the discussion and it takes less than the reportable 15 minutes, can it be billed at all? I think not.

 

[jkyles]

I agree that it can't be billed separately.