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| March 2016 | Archive |
Advance Care Planning
As difficult as these conversations are for us as trained professionals, think of your patients. I believe we have a real opportunity to help our patients and their families improve the chances of making their wishes known and ensuring those wishes are followed. ACP involves multiple steps designed to help individuals, including learning about the health care options that are available for end-of life care, determining which types of care best fit their personal wishes, and sharing their wishes with their family, friends, and physicians. ACP discussions are an important part of patient- and family-centered care. Patients and families can now have these discussions when and where they want—before patients become ill, after they receive a diagnosis of a terminal illness, or while they are receiving hospice or palliative care. Conversations typically involve identifying patients’ goals of care, discussing ACP, and helping patients understand advance directives, which are helpful tools for patients, their family caregivers, and the professionals caring for them during the course of an illness. ACP involves multiple steps designed to help individuals learn about the health care options available for end-of-life care. Patient ExampleA 68-year-old male with congestive heart failure (CHF) and diabetes who takes multiple medications is seen by his physician for management of these two diseases. In addition to discussing short-term treatment options such as medication adjustment, the patient asks about long-term treatment options, such as a heart transplant if his CHF worsens. ACP would include the patient’s desire for care and treatment if he suffers a health event that adversely affects his decision-making capacity. In this case, the physician would report a standard E/M code and one or both of the ACP codes (depending on the duration of the ACP service), determine which types of care best fit the patient’s wishes, and share his wishes with family, friends, and other appropriate physicians. These discussions are considered educational; and while you may cover information and/or complete forms such as advance directives or Do Not Resuscitate orders, there is no requirement that these forms be completed during the session. ACP services are voluntary and patients should be given an opportunity to decline or receive them. This service may be provided to a patient and/or his or her family member or health care surrogate, using proper HIPAA practices. This service must be administered face-to-face. Reimbursement for ACPThere are two Medicare billing codes for ACP, one code (99497) for the first 30 minutes and a second add-on code (99498) for additional 30-minute conversations. Physicians may also include this service as part of patient’s annual check-up (payment under HCPCS code G0438 or G0439, ACP should be reported with modifier -33, and there will be no coinsurance or deductible). These are time-based codes; therefore, an attestation should be included. Given that these are time-based codes, documentation should include reference to the specific time spent and issues discussed. The following are examples: 99497: “I spent 30 minutes discussing code status with Mrs. Jones and her family.” 99498: “I spent an additional 30 minutes with the Jones family reviewing and answering questions about the advance directive of Mrs. Jones.” Billing for ACPEffective January 1, 2016, Medicare will reimburse physicians for ACP conversations with patients. These codes are billable under Medicare Part B and some private insurers. They can be used by any physician or nonphysician practitioner who bills Part B for their services. HCPCS Code 99497 HCPCS Code 99498 Eligible ProvidersACP counseling is payable to any qualified health provider with the training necessary to provide this service. These include: RN; Certified NP; PA-C; Licensed Masters Social Worker (LMSW); Psychologist (LLP and PhD); Certified Diabetes Educator (CDE); Registered Dietitian; and Masters-trained Nutritionist Clinical Pharmacist Respiratory Therapist. *ACP cannot be reported with critical care codes. Referrals (407) 682-9090 | PlanForHospice.com Required DocumentationThe following represent the minimum documentation requirements for ACP discussions:
Final Notes to Keep in MindA provider is able to submit codes documenting repeat planning discussions. More than one session may be required and is allowed if proper documentation supports the need. The planning may take place at any time. ACP can be the sole reason for the visit or can be billed in addition to another office visit on the same day (eg, 99214 and 99497). ACP can be separately billed in addition to a wellness visit. (Payment under HCPCS code G0438 or G0439, ACP should be reported with modifier -33, and there will be no coinsurance or deductible.) The beneficiaries’ usual cost-sharing fees apply (except when conducted in a wellness visit). — Rosemary Laird, MD, MHSA, AGSF, is a geriatrician, executive medical director of senior services for Florida Hospital at Winter Park, and past president of the Florida Geriatrics Society. She is a coauthor of Take Your Oxygen First: Protecting Your Health and Happiness While Caring for a Loved One With Memory Loss.
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