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Diag codes to be used with 99497 and 99498

  1. Default Diag codes to be used with 99497 and 99498
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    Does anyone know what ICD-10 code can be used with the new End of Life Care CPT codes 99497 and 99498? I believe the HCPCS code might be S0257. For non-medicare patients Z02.89 looked like it might be suitable, but I'm not sure. Does anyone have advice? I have also received mixed messages on whether or not the half rule applies to 99497. Does a physician need to spend at least 16 minutes with the patient planning or does anytime with the first 30 minutes apply?

  2. Default
    I used Z71.89 family counseling and all my claims were denied as non-covered services because this is a routine exam. I am going to call Medicare today to see if they give me any info since this is a newly payable code by Medicare. I will respond with hopefully a good dx to use

  3. #3
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    Bentonville, Arkansas
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    Default Acp
    I looked around quite a bit yesterday for guidance on these codes, but found none. There is no guidance as to whether 99497 has to be 30 minutes or up to 30 minutes, and not one article addresses the ICD10 coding for this service. The "feeling" I got was that since Medicare is just starting to pay for this, CMS is waiting for the local carriers to develop LCD policies. I wonder if you could use any comorbid codes. The transmittal number is R216BP and the implementation date is 01/04/2016, but that is all the guidance there is.

  4. Default
    We are using Z00.00, and have not rec'd any denials or payments yet. We should know in a few days and I will let you know.

  5. Default 99497 denials
    I've billed 99497 using Z00.00 since there is no guidance from Medicare on what code to use. All my claims have been denied. Medicare does not know what code should be used, they say I billed it correctly with modifier 33 in conjunction with a Wellness code, but they don't know what ICD10 I should use. They told me to contact the AMA. The AMA told be to contact AHA Coding Clinic Advisor on line. I tried to submit a question but you have to join the organization to do so. Has anyone figured out the right ICD10?? Sure would help make up for all the 'dings' we're getting on payments.

    Thanks!

  6. Default
    We are experiencing issues getting this paid as well. We have been linking it with the Z00.00/Z00.01 as we were advised; however, all of our claims that we submitted with this code AND the mod 33 are being bundled. Has anyone found the answer to this problem? Should we be linking it to a critical DX?

    Thanks,
    Sarah

  7. Default
    Quote Originally Posted by amoneill118 View Post
    does anyone know what icd-10 code can be used with the new end of life care cpt codes 99497 and 99498? I believe the hcpcs code might be s0257. For non-medicare patients z02.89 looked like it might be suitable, but i'm not sure. Does anyone have advice? I have also received mixed messages on whether or not the half rule applies to 99497. Does a physician need to spend at least 16 minutes with the patient planning or does anytime with the first 30 minutes apply?
    i've billed g0439 and 99497 with no modifier and medicare did not make any payments, but allowed us to bill the patient for it.

  8. Default
    Hi everyone,

    I thought I was the only one going crazy trying to figure out what ICD-10 code to use! I'm glad I stumbled upon this forum. Has anyone figured out or have gotten any response from Medicare as to what dx code needs to be used for ACP? We are just about to start to bill for it. I've tried reading around the internet and I could not find any information as to what ICD-10 code to be used. Any response would be greatly appreciated.

  9. #9
    Default
    Please read the following article, in particularly the comments. While this information is not official, there is some good discussion. I read that the diagnosis codes should be the patients problems. As far as time is concerned, CMS says they are abiding by the CPT time threshold.

    http://nicolettinotes.com/2015/12/02...g-99497-99498/

    There is an official CMS transmittal as well as MLN Matters on line. I have contacted my MAC in hopes that they will hurry and provide further guidance. As of today, they have nothing on their site. CMS has indicated that they are waiting for provider implementation prior to instituting any further official guidance.
    Patricia Koenig-Claybaugh RHIT CCA CPC CPMA

  10. Question Dx
    All the discussions I have read seem to talk about using a counseling Dx when billing for ACP. I was wondering if anyone had tried Z51.5? Description reads "Encounter for palliative care" which includes "Dying/death measures"

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