Physicians started the new year with two new billing codes for advance care planning. As of January 1, 2016, The Centers for Medicare and Medicaid Services (CMS) will now pay physicians for discussing advance care planning with their patients. These conversations can include advance directives, terminal diagnoses and end-of-life care options.
You can read the CMS announcement here.
Advance Care Planning Codes
CPT Code 99497 - First Half Hour
Advance care planning including 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 professionals; first 30 minutes, face-to-face with the patient, family member(s), and/or surrogate.
CPT Code 99498 - Each Additional Half Hour
Advance care planning including 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; each additional 30 minutes (List separately in addition to code for primary procedure.)
How It Works
Doctors can use the two codes to tailor their advance care planning conversations to each patient. For example, if the doctor spends a half-hour discussing the patient's goals and options, and then another half-hour reviewing an advance directive with the patient, they would use code 99497 for the first half-hour of an advance care planning conversation and code 99498 for the additional time.
These conversations may take place at any point in the patient's care and could happen at:
- A doctor's office
- During an inpatient stay
- An outpatient visit
- In the patient's home
Initiating conversations about end of life can be difficult, but they are essential to ensuring the patient's wishes are met.
For additional information on how to have an advance care planning conversation about hospice, please read Approaching the Hospice Conversation: Best Practices for Physicians.
For families wishing to begin the discussion at home, The Conversation Project has a free Starter Kit to help guide patients and families through the discussions about what matters most to each other.
If you found this information helpful, please share it with your network and community.
Copyright © 2016 Crossroads Hospice. All rights reserved.