tci Outpatient Facility Coding Alert - 2017 Issue 4

Reader Question: Make Sure You're Clear on Advance Care Planning Payment

Question: Our physician saw a patient for advance care planning and reported 99497 for the service. We waived the deductible and coinsurance per Medicare rules, but then our payer said that the patient should have paid the coinsurance. Our surgery center doesn’t commonly bill this code, so we aren’t sure what we’re doing wrong. Subscriber Answer: It’s likely that you administered the advance care planning by itself or with a problem-based E/M service (e.g., 99213) and not with an annual wellness visit (G0438 or G0439). Medicare only waives the deductible and coinsurance...

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