POLST Form billing

troddick

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Can anyone give advice on POLST form billing... We have a POLST form completed from last year. This year, the provider re-reviewed and documented the conversation about the patient's plans and decisions, no changes were made. Does a new form need to be filled out in order to bill for the advanced care planning, or is the documentation for this year sufficient?
 

npjohnson

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POLST Form Billing

CMS Published this answer in their frequently asked questions:

1. CPT codes 99497 and 99498 are time-based codes (a base code and an add-on code). Are there minimum amounts of time required to bill these codes?
In the calendar year (CY) 2016 PFS final rule (80 Fed. Reg. 70956), we adopted the CPT codes and CPT provisions regarding the reporting of timed services. Practitioners should consult CPT provisions regarding minimum time required to report timed services. If the required minimum time is not spent with the beneficiary, family member(s) and/or surrogate to bill CPT codes 99497 or 99498, the practitioner may consider billing a different evaluation and management (E/M) service such as an office visit, provided the requirements for billing the other E/M service are met.
https://www.cms.gov/Medicare/Medica...Sched/Downloads/FAQ-Advance-Care-Planning.pdf

CPT guidelines say that, "A unit of time is attained when the mid-point is passed. For example, , an hour is attained when 31 minutes have elapsed (more than midway between zero and 60 minutes)."
AMA CPT 2017 Professional, page xv.

So no, 5 minutes does not satisfy the time requirement. CPT rules require at least 16 minutes documented to bill 99497, and at least 46 minutes must be documented to bill both 99497 and 99498.

Hope this helps.

Neal Johnson, CPC, CPMA
 

npjohnson

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Polst Form Billing

I posted my other response to the wrong thread. sorry about confusion.

To answer your question, the CPT description under "Advance Care Planning" states, "with or without completing legal forms." (page 51 in my AMA CPT 2017 professional). So as long as documentation discusses it and the time is documented and appropriate, you can bill for it.

Check out the CMS FAQ that I posted earlier.
https://www.cms.gov/Medicare/Medica...Sched/Downloads/FAQ-Advance-Care-Planning.pdf

Hope this helps.

Neal Johnson, CPC, CPMA
 
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