The Critical Element in Billing Medicare for Telemedicine

Betsy Nicoletti, MS


May 28, 2019

In This Article

Post-discharge Medication Reconciliation

Question: I am a pediatrician at a rural family medical center. Are there any codes for medication reconciliation after hospital or ER discharge?

Answer: Medication reconciliation is a required component of transitional care management, which may be billed when a patient is discharged from an inpatient, observation, partial hospitalization, or nursing facility to a nonfacility setting (home, rest home, domiciliary care, or independent living). TCM codes 99495 and 99496 have many specific, additional requirements.

TCM services are used for patients with medical and/or psychosocial complexity requiring moderate- or high-complexity medical decision-making (MDM). The practice must call the patient within 2 business days, perform an E/M service within 7 days for patients with high-complexity MDM, and within 14 days for patients with moderate-complexity MDM.

Additionally, Current Procedural Terminology (CPT) states, "TCM is comprised of one face-to-face visit within the specified timeframes, in combination with non-face-to-face services that may be performed by the physician or other qualified health care professional and/or licensed clinical staff under his/her direction."[2]

CPT code 1111F (Discharge medications reconciled with the current medication list in outpatient medical record) may be reported, but it is a Category II CPT code, which is a supplemental tracking code that can be used for performance measurement. However, 1111F does not have any relative value units or payment associated with it.

Correct Coding for Advanced Care Planning

Question: What is the best way to bill for goals of care/end-of-life planning discussions? As an oncologist, these conversations take a significant amount of my time.

Answer: For these discussions, use Advance Care Planning codes 99497 and 99498.

Code 99497 for advance care planning includes the explanation and discussion of advance directives such as standard forms (with completion of such forms, when performed) by the physician or other qualified healthcare professional—the first 30 minutes, face-to-face with the patient, family member(s), and/or surrogate.

Use code 99498 for each additional 30 minutes spent with the patient.

These codes may be performed on the same day as an E/M service, except critical care, or on a day when no other service is provided. These are time-based codes, and the time spent in the discussion must be documented in the medical record. The discussion may be with the patient, family member, and/or surrogate.

The codes follow the CPT rule for time: "A unit of time is attained when the mid-point is passed. For example, an hour is attained when 31 minutes have elapsed (more than midway between zero and sixty minutes)."[3]

That is, bill 99497 when the service takes over 15 minutes, and add on 99498 if the service takes over 45 minutes. Do not double-count the time spent in performing any other services with the time in advance care planning.

Have a coding question? Send it in and it may be answered in a future column. (Please be sure to note your specialty in the text of the question.)


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