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Advance Care Planning

Michael Posted Fri 29th of January, 2016 19:12:40 PM

We have a Provider-Based clinic and would like to know if a doctor talks to a patient about Advance Care Planning (cpt 99497 & 99498) and then sends that patient to a social worker to complete the forms can we bill for the entire combined time?

For example:
The patent talks with the doctor for 5 min and then spends 45 min filling out the forms with the social worker. Can we use the entire time 50 min and bill the services out in the doctors name?

SuperCoder Answered Mon 01st of February, 2016 04:56:26 AM

Yes, we can bill the entire 50 minutes with cpt code 99497 and 99498 for Advanced Care Planning (ACP), as this code includes explanation and discussion of advance directives (a document appointing an agent and/or recording the wishes of a patient pertaining to his/her medical treatment at a future time should he/she lack decisional capacity at that time). Below is the link that will give more clearity on ACP.
Also check the payers policy.

Michael Posted Mon 01st of February, 2016 12:10:25 PM

Just wanted to make sure that you saw that this is a “Provider-Based” clinic, (which is a Medicare status for hospitals and clinics that meet specific Medicare regulations and requires that we bill Medicare in two parts — one bill for the physician service, and another bill for the hospital/facility resources and services.) So you are saying that even though incident-to services are not allowable in this type of location we can still bill for the social worker’s time? Can you please provide me with any documentation that states this as the link above makes no reference to someone other than the doctor providing the service.

SuperCoder Answered Tue 02nd of February, 2016 07:38:45 AM

Providers of ACP: While CMS recognizes the role of other providers in the provision of ACP services (such as social workers, chaplains, and others).

Location of Services: ACP services are appropriately furnished in a variety of settings, and are separately payable to the billing physician or practitioner in both facility and non-facility settings and are not limited to particular physician specialties. CMS has also provided for payment of ACP services to hospitals when such services are provided in an outpatient department under the CY2016 hospital outpatient prospective payment system final rule.

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