Wiki e/m coding for end of life care

[misstigris]

Hello-I am posting this again as I am still in need of some help in coding this scenario...

Patient comes in to see physician to discuss end of life planning. Patient is healthy, but wants to plan ahead and has discussion with physician about filling out advance directive and POLST forms.

What CPT and ICD-9 codes would you use?

I have tried billing 99213 w/ V65.49 (but was denied)

--I ran across this code
HCPCS code S0257- but not sure when to use., and Medicare won't accept

It has been suggested to use V66.7, but this code does not seem appropriate as pt is not sick..

another suggestion was: 99429 the unlisted preventive medicine service. For a dx I would use V65.8.

Any ideas would be greatly appreciated.
Thanks

 

[FTessaBartels]

One of two options

There is no chief complaint here and no medical necessity for an E/M visit of any kind. It's not really a preventive examination (as there is NO exam).

I would have a practice policy in place that reflected one of these two options:

Option 1) Such visits are for established patients only, and are done without charge.

Option 2) Such visits are considered administrative and are billed directly to the patient at a flat fee $xx (probably higher than just filling out a form if the provider is going to actually meet with the patient face-to-face)

Hope that helps.

F Tessa Bartels, CPC, CEMC