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5404End of Life Counseling Billing Code?

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  • Melinda
    Mar 17, 2011

      I could really use your help. Had a patient just come in for "end of
      life planning" only - AGAIN!!!! 2 days ago. I"m a little ticked at
      scheduling. He tried to charge a 99213 and I told him it wouldn't fly.

      Is there an End of Life Planning code, for billing? Dr says "I thought
      that Congress approved this last year - please check with your coding
      folks - it seems to me that there is a code."

      Here's what I've found:

      HCPC S0257 - "Counseling and discussion regarding advance directives or
      end of life care planning and decisions, with paient and/or
      surrogate(list separately in addition to code for appropriate evaluation
      and management (E/M) service." However, it's not payable by Medicare.

      My feeling is completion of these forms should addressed at the Annual
      Wellness Vists (G0438 initial, G0439 estab); which Medicare now pays
      for, effective January 1, 2011. It is considered part of that exam.

      End of life planning is included as payable with Medicare, but only
      under the Annual Wellness Visit (AWV) exam (physical exam) that they
      began reimbursing for in 2011.

      "The final version of the health-care legislation, signed into law by
      President Obama in March, authorized Medicare coverage of yearly
      physical examinations, or wellness visits. The new rule says Medicare
      will cover "voluntary advance-care planning," to discuss end-of-life
      treatment, as part of the annual visit."

      "Under that proposal, doctors would have been able to bill Medicare
      separately for advance-care planning consultations once every five
      years, or when a patient's health changed dramatically. The plan also
      suggested that physician performance could be measured in part by
      whether patients had advance directives or living wills. Under heavy
      fire, its authors stripped the provision out of the reform bill."

      So, coders and billers out there, I'm looking for your take on this.
      How should this be being billed?

      I would appreciate your feedback. Thanks!

      Melinda Brown, CMBS - Ins Biller

      [Non-text portions of this message have been removed]