Health Information Management

Tip: CMS adds payment for advance care planning in certain scenarios

APCs Insider, January 15, 2016

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CMS changed the status indicator for CPT code 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 other qualified health care professional; first 30 minutes, face-to-face with the patient, family member, and/or surrogate) from N (no additional payment, payment included in line items with APCs for incidental service) to Q1 in the 2016 OPPS final rule.

This means that separate payment will be provided when this service is provided on a date of service without a visit (status indicator V) or procedure (status indicator S or T).
Add-on code 99498 (advance care planning; each additional 30 minutes), like most other add-on codes under the OPPS, is unconditionally packaged and assigned status indicator N.
This tip is adapted from “CMS shifts 2-midnight rule responsibility to QIOs, finalizes packaging expansion” in the January issue of Briefings on APCs.

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