tci E/M Coding Alert - 2020 Issue Q3

Reader Questions: End This EOL Modifier Mistake

Question: Our provider recently counseled an established patient on end-of-life (EOL) directives during an E/M visit. We billed 99215-25 and 99497-59; +99498-59, but the payer denied the claim with the response “The procedure code is inconsistent with the modifier used or a required modifier is missing.” Can you advise us as to what we did wrong? Michigan Subscriber Answer: The issue here is likely the use of modifiers on the 99497 (Advance care planning including the explanation and discussion of advance directives such as standard forms (with completion of such forms, when performed), by the physician or...

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