Advance Care Planning for Patients
Advance care planning (ACP) is a process that involves making decisions about your future healthcare preferences and communicating them to your loved ones and healthcare providers. It allows individuals to plan and express their wishes regarding medical treatments and end-of-life care, particularly in the event that they become unable to make decisions for themselves.
The goal of advance care planning is to ensure that your healthcare preferences are respected and followed, even if you cannot communicate them directly. It guides your family, caregivers, and medical professionals on how you wish to be treated in different medical situations.
Here are some critical components of advanced care planning:
- Living Will: A living will is a legal document that outlines your healthcare preferences in specific medical situations. It may include instructions about life-sustaining treatments such as resuscitation, mechanical ventilation, tube feeding, and palliative care. It becomes effective if you cannot communicate or make decisions for yourself.
- Healthcare Proxy or Durable Power of Attorney for Healthcare: This is a legal document that designates a trusted person, often called a healthcare proxy or agent, to make medical decisions on your behalf if you become incapacitated. It is essential to choose someone who understands your values and will advocate for your preferences.
- Discussion and Communication: Advance care planning involves having open and honest conversations with your loved ones and healthcare providers about your values, beliefs, and goals regarding medical treatment and end-of-life care. These discussions help ensure that everyone understands your wishes and can make informed decisions on your behalf.
- Documentation and Access: It is crucial to document your advance care planning preferences and ensure they are easily accessible. Provide copies of your living will, healthcare proxy designation, and other relevant documents to your healthcare proxy, family members, and healthcare providers. It is also essential to regularly review and update your preferences as your circumstances or priorities change.
- Medical Orders for Life-Sustaining Treatment (MOLST) or Physician Orders for Life-Sustaining Treatment (POLST): These portable documents are typically completed with the assistance of a healthcare professional and are signed by both you and your healthcare provider.
- Advance care planning is not limited to elderly or terminally ill individuals. It is recommended for all adults, regardless of age or health status, as unexpected medical emergencies can occur anytime. Engaging in advance care planning empowers you to have a voice in your medical care and ensures your wishes are honored when you cannot express them. It is advisable to consult with a legal professional or healthcare provider to ensure that your advance care planning documents comply with local laws and regulations.
Advance Care Planning Billing – Information for Group Medical Practices and Solo Providers
ACP discussions can be conducted by various healthcare professionals, including physicians, nurse practitioners, and social workers. Effective networking in healthcare can also play a role in facilitating these important conversations. The fees for ACP services can vary depending on the provider’s expertise, qualifications, and the duration of the session.
Medicare covers advance care planning discussions as a separate service under the Medicare Part B benefit. Medicaid and other insurance programs have guidelines and coverage policies for ACP discussions.
The Centers for Medicare & Medicaid Services (CMS) has revised its advance care planning (ACP) fact sheet to clarify the documentation and time requirements for this service. It highlights the following points.
- Documentation of ACP discussions must include the following:
- The voluntary nature of the visit,
- The explanation of advance directives,
- Who was present (the patient, family member, caregiver, or surrogate),
- The time spent discussing ACP during the face-to-face encounter,
- Any change in health status or health care wishes if the patient cannot make health decisions.
- ACP services are time-based and subject to CPT rules such as the following:
- Time spent on other services performed concurrently (e.g., active management of a patient’s issues) does not count toward time spent on ACP,
- CPT code 99497 covers the first 30 minutes, while code 99498 covers each additional 30 minutes,
- ACP discussions of 15 minutes or less cannot be billed as ACP services but can be billed as a different E/M service (e.g., an office visit) if the other service’s requirements are met,
- A unit of time is billable when the time spent passes the midpoint (e.g., 16-45 minutes would be 1 unit of 99497, 46-75 minutes would be 1 unit of 99497 and 1 unit of 99498, and 76-105 minutes would be 1 unit of 99497 and 2 units of 99498).
- ACP Minutes & Corresponding CPT Codes
- ACP Codes less than 15 minutes – Don’t bill any ACP services.
- ACP minutes between 16–45: CPT code 99497 (1 unit)
- ACP minutes between 46–75: CPT code 99497 (1 unit) and CPT code 99498 (1 unit)
- ACP minutes between 76–105: CPT code 99497 (1 unit) and CPT code 99498 (2 units)
| Code | Description | ACP Medicare Allowed Amount |
| 99497 | 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 health care professional; first 30 minutes, face-to-face with the patient, family member(s), and/or surrogate | $82.82 |
| 99498 | 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 health care professional; each additional 30 minutes (List separately in addition to code for primary procedure) | $72.11 |
You shouldn’t discuss any other active management of a patient’s issues for the time reported when you bill ACP codes. When you perform another service concurrently as a time-based service, don’t include the time spent on the concurrent service with the time-based service. Don’t bill any ACP discussion of 15 minutes or less as ACP services. Bill a different Evaluation and Management (E/M) service, like an office visit (if you meet the other service’s requirements). A unit of time is billable when the midpoint of the allowable unit of time passes.
- Include:
- Medical orders for life-sustaining treatment and psychiatric advance directives as examples of advance directives
- No specific diagnosis is required for the ACP codes to be billed. An ICD-10 code pertaining to the condition for which counseling is being provided or to reflect an administrative examination or a well-exam diagnosis when furnished as part of the AWV.
Diagnosis Report the condition you discuss with the patient using an ICD-10-CM code. This code shows an administrative exam or an exam diagnosis when the ACP services are part of the Annual Wellness Visit (AWV) or Initial Preventive Physical Exam (IPPE). You don’t need to report a specific diagnosis to bill ACP.
Remember, the billing for ACP services can be complex and may depend on various factors. It is recommended that you consult with a professional medical billing service to understand the specific billing procedures, coverage, and potential costs associated with advance care planning services in your location. Also, ensure that you educate your patients about ACP. Sharing this blog post in subsequent patient communications can be the first step!
