99498 . . . each additional 30 minutes (list separately in addition QUICK LOOK! THE JOURNAL OF THE HEALTHCARE BILLING AND MANAGEMENT ASSOCIATION 35 to code for primary procedure) This is defined as a face-to-face meeting between a physician/practitioner and a patient, family member, or surrogate for counseling and discussion of advance directives. Examples of advance directives include healthcare proxy, durable power of attorney for healthcare, living will, and medical orders for life-sustaining treatment. Codes 99497 and 99498 include the completion of the advance directive forms, but form completion is not required in order to report these codes. For example, if the patient or surrogate needs more time to consider the options, the advance care planning encounter may conclude without the patient actually executing an advance directive. The advance care planning codes can be reported on the same day as an E/M service, with the exception of critical care (99291- 99292), inpatient neonatal/pediatric critical care (99468-99476), and initial and continuing intensive care services (99477-99480). The physician/practitioner should not be actively managing the patient’s health problems during the time reported for advance care planning. CMS has decided not to pay for advance care planning during 2015; however, they are accepting comments on these codes and will make a new determination next year based on the comments. Maternity Care One other E/M change is found in the maternity care and delivery section of the CPT manual, rather than in the E/M section. The maternity care guidelines have been revised to clarify that pregnancy confirmation during a problem-oriented or preventive E/M visit is not included in antepartum care and should be reported with the E/M code for the problem-oriented or preventive visit. Antepartum care, on the other hand, includes the initial prenatal history and physical examination. For example, if a woman visits her family practitioner or OBGYN for an annual physical and is found at that time to be pregnant, the preventive visit code can be reported for that encounter even if the same physician subsequently provides the patient’s maternity care. Changes to Global Surgery Policy As always, it is important to monitor payor bulletins for information about billing requirements and coverage for the new codes and to work with clients to ensure they understand the reporting restrictions. And there is one other factor to keep in mind: CMS announced in the 2015 Physician Fee Schedule Final Rule that it has decided to proceed with its proposal to change the Medicare global surgery policy. Beginning in 2017, all procedures with 10- day global periods will be converted to 0-day, and in 2018, all procedures with 90-day global periods will be converted to 0-day. Once the new policy has been implemented, physicians who perform surgical procedures will be billing for many more E/M services than they do currently. This makes it even more important for your clients to understand and comply with the E/M documentation guidelines and reporting rules. ■ Jackie Miller, RHIA, CCS-P, CPC, is vice president of product development at Coding Strategies, Inc. A SAMPLING OF E/M CODE CHANGES • The E/M guidelines section of the CPT manual now includes "military history" as a topic included in the patient's social history. • The codes for neonatal total body systemic hypothermia (99481) and selective head hypothermia (99482) have been deleted. A new hypothermia code (99184) and guidelines have been added. • The "Complex Chronic Care Coordination Services" section has been renamed "Care Management Services" and now contains two subsections: chronic care management (99490) and complex chronic care management (99487, 99489). The CPT manual includes new and revised guidelines for these codes. • Two new codes have been created for advance planning (99497, 99498).
Billing_MarApr15
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