Question Advanced Care Planning Coding denials 99498

Rak1113

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I am getting denials from Medicare when billing 99497, 99498, and 99498. The time documentation is appropriate. Medicare is paying the 99497 and the first 99498, however they are denying the second as a "duplicate." Has anyone ran into this issue?
Would a modifier be appropriate with the second 99498? If so which one?
 

unicorn80

Networker
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Neenah, WI
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I am wondering if the second 99498 you assigned is because it didn't meet the full 30 minutes. Maybe the patient only was seen for 1 hr 15 minutes so your first two codes covered the 1 hour but your 3rd code did not cover the full 30 so that is my guess as to why it was denied. Can you add a modifier for reduced services since the full 30 minutes wasn't met if that is the reason for them denying the second 99498? The modifier for reduced services is 52. You may have to notate on the second 99498 code that the patient was only seen for x amount of time so Medicare knows the reason for assigning modifier 52. I hope this helps :)
 

SharonCollachi

True Blue
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Clovis, CA
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In my experience, time-based codes are not eligible for reduced services.

OP, did you bill with a total of three lines, meaning one line of 99497, one line of 99498, one line of 99498? Or did you bill 2 units of 99498, all on one line? This is what it should look like:

1 unit 99497
2 units 99498
 
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