New Billing Code Available for Advance Care Planning

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As of January 1, 2016, when you make rounds there is another billing code available to you for work that you likely already are doing.  They are billing codes for Advance Care Planning, termed the “Voluntary Advance Care Planning” also known as  “Voluntary ACP.”

How does it work?

When you or your non-physician practitioner, such as a nurse practitioner, make rounds and have a face-to-face encounter with a patient or responsible party – a family member with power of attorney – and discuss advance directives, this is a billable service.  You must document the discussion, which should include description of the patient’s wishes relative to future medical treatment.

Essentially, you’ll be discussing advance directives. An advance directive is defined as a document appointing an agent and/or recording the wishes of a patient pertaining to his or her medical treatment at a future time should he or she lack decision-making capacity at that time.  It is appropriate and necessary to discuss the options, and while appropriate associated  paperwork, such as a transfer to hospital form, POLST form or living will may be completed or discussed as part of this interaction, this is not a required part of the visit for billing purposes.  A physical examination is not even required.

The CPT code is 99497, and if the discussion and related work takes over 30 minutes, you may submit a 99498 add-on code for each additional 30 minutes taken on the same day.  This initially may seem unlikely to some, but a family conference easily could take up over an hour’s time.

Because advance care planning is often an iterative process, wherein a patient or family may not be able to make up their mind at first, this code may be used repeatedly on different dates. Naturally CMS would be on the lookout for abuse of the code, but appropriate documentation should protect you.

This “Voluntary Advance Care Planning” service as it is called also may be performed as a part of an annual wellness visit, but if you do so, you need to attach a -33 modifier to waive the patient copay.  You would be able to bill for both the annual wellness visit and the advance care planning on the same visit, but understandably the patient should not be responsible for two copays.

Why is this important?

Hopefully you already are discussing advance directives and advance care planning with your patients in the LivingCenters. Now you at least can get some reimbursement for the time spent.  At Golden Living, our philosophy and mission is patient and family centered.  Discussing a patient’s wishes empowers them and may save a patient from care that may be more aggressive or invasive than they would have wished.  Alternatively, some patients do wish for measures to be taken, as is their right, and this will reinforce their desires.  Both of these situations especially are important when family members disagree with each other.  Much strife can be circumvented when the questions are asked early in a patient’s stay, as opposed to at the moment of change in condition when everyone needs an answer quickly.

For more information:

You may find more information about this code through the following link:
https://www.cms.gov/Regulations-and-Guidance/Guidance/Transmittals/Downloads/R216BP.pdf

A list of frequently asked questions and answers regarding this CPT code can be found at:
https://www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/PhysicianFeeSched/Downloads/FAQ-Advance-Care-Planning.pdf

Please share this information with your associates and medical staff and feel free to contact me or your Regional Medical Director if you have further questions.

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