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Visit re: Advanced Directives

  1. #1
    Default Visit re: Advanced Directives
    Medical Coding Books
    Hi all, I'm trying to find out the proper method, if any, to bill for a counseling visit re: Advanced Directives forms that were recently sent to all our patients over 18.

    I personally think that it's billable if the provider is spending 10-30 minutes counseling on the risks/benefits of life support treatments and which ones the patient would or would not prefer to undergo, end of life care, donating organs and autopsies, that it falls into the counseling definition of the AMA:

    AMA Comment: The CPT nomenclature defines counseling, as it relates to E/M coding, as a discussion with the patient and/or family or other caregiver concerning one or more of the following areas: diagnostic results, impressions, and/or recommended diagnostic studies; prognosis; risks and benefits of management (treatment) options; instructions for management (treatment) and/or follow-up; importance of compliance with chosen management (treatment) options; risk factor reduction; and patient and family education.

    I'm being told "I don't see why this would be considered medically necessary and qualify for counseling or time."

    Can I get some feedback? I want to understand why this is non-billable, if that is the case.

    FYI - I do understand that when a patient brings in a completed form during their visit, that it is not billable, as it is already signed and just ready to be filed in the patient's chart.

    Another thing to think about... What if the patient is here for hypertension and it would normally be a 10 minute visit and these questions come up re: Advanced Directives, so the visit is now a 30 minute visit. Is that time now allowed to be included in the E/M for counseling?
    Heidi Thompson, CPC

  2. #2
    Ok, your office sent out information that was not solicited to all patients over 18 and if the patients ask your doctors questions about it you want to charge them? I have a hard time seeing the medical necessity in that myself.

    Medicare actually includes advance directives in something, the Welcome to Medicare exam, I think.

    Just my opinion,

    Laura, CPC

  3. #3
    Thank you for your opinion.

    You didn't speak to whether or not you felt the time would be considered if this same discussion took place during a normal office visit for another condition?
    Heidi Thompson, CPC

  4. #4
    I think if it was related to the issue they were being seen for and was reasonable, then yes, I would count it.

    Even time based E/Ms have to be medically necessary.

    So if this was normally a 5 min visit because of seasonal allergies in a healthy 18 year old and they spend an additional 45 minutes discussing end of life planning I think you would have a hard time supporting a 99215 even though the time is there.

    Just my opinion,

    Laura, CPC

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