ACP billed in addition to E/M service

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Joined: Sat Dec 20, 2014 9:32 pm

Wed Aug 30, 2017 8:57 am


Our coding team has received the following question from one of our Palliative providers regarding billing Medicare for Goals of Care and Advanced Care Planning performed on the same day. Can anyone help with this question? Thank you in advance! I am including a scenario below

"For an initial consult, how best to use the ACP codes? Is this a case where it is part of the overall consult with GOC/ ACP or is this a case when this could be an initial consult AND also separate note for ACP in the same day?
The issue is a bit fuzzy".

We are thinking these might be some options:
1. Document two separate notes each with details of discussions and times that devoted to each and submit to insurance and track what happens.
2. Contact Noridian directly for an answer.
3. Contact Palliative Care Association and see if they can offer guidance.

A 68-year-old male with heart failure and diabetes is on multiple medications. He is seen by his physician for the Evaluation and Management (E/M) of these two diseases, including adjusting medications as appropriate.
In addition to discussing the patient’s short-term treatment options, the patient expresses his interest in discussing long-term treatment options. The doctor and patient talk over the possibility of a heart transplant if his congestive heart failure worsens, and ACP. That includes discussing the patient’s desire for care and treatment if he suffers a health event that adversely affects his decision-making abilities.
In this case, the physician would report a standard E/M code for the E/M service and one or both of the ACP codes, depending on the duration of the ACP service.

In the case above, medications are being adjusted. However, there are many times the palliative care providers are coordinating care or counseling but not actively treating the disease. Would Medicare still cover this? (The example above was payable).

Thank you!
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