Question

This 87 year old established patient is seen in the office by her primary care physician for congestive heart failure and hypertension. The doctor performs a detailed history and exam with medical decision making of moderate complexity. She also asked to discuss and document the wishes of further medical treatment if, at a future time, she lacks the capacity to make those decisions. Her daughter is present as Power of Attorney and a Living Will was established. 35 minutes is documented for the discussion. How would these services be billed by the provider?

1) 99214, 99354

2) 99214 - 25, 99402

3) 99214, 99497 - 25

4) 99214 - 25, 99497

Answer 1

These service would be billed as 99214 - 25, 99497 by the provider.

This is because 99214 represents office visit of a established patient(mentioned in the question) for evaluation and management. Modifier 25 indicates separately identifiable E/M on the same day of a procedure including detailed history and examination (The doctor performs a detailed history and exam)

And the most important 99497 represents Advance care planning (medical decision making of moderate complexity) including the explanation and discussion of advance directives (She also asked to discuss and document the wishes of further medical treatment if, at a future time, she lacks the capacity to make those decisions), by the physician ; first 30 minutes, face-to-face with the patient, family (Her daughter is present as Power of Attorney)