Use of Advance Care Planning Billing Codes in a Tertiary Care Center Setting

Abstract

Introduction: The Centers for Medicare and Medicaid Services released the final payment rules for reimbursement of advance care planning (ACP) effective January 2016. In its first year, 23,000 providers nationwide submitted 624,000 claims using the Current Procedural Terminology codes 99497 and 99498. The objectives of our study were to 1) assess the frequency of ACP codes used at a single academic tertiary care center in Iowa, 2) determine when and by whom the codes were used, and 3) summarize ACP clinical notes. Methods: Using the electronic medical record data warehouse from a single tertiary teaching hospital and affiliated clinics, date of service, department where service was provided, provider name and type, patient medical record number, date of birth, and gender linked to the ACP codes 99497 and 99498 were collected. The content of ACP clinical notes were reviewed and summarized. Study period was from January 1, 2016 through September 19, 2018. Results: During the 33 months, code 99497 was used 17 times and code 99498 was never used. Code 99497 was successfully reimbursed 4 times. Discussion: Charges were not reimbursed if the ACP visits did not meet the minimum time requirement or were conducted by an individual not considered a qualified health care professional per Medicare rules. Conclusion: ACP codes 99497 and 99498 were very rarely used at this tertiary care center during the initial 33-months after the Medicare rules went into effect. Interventions are needed to promote the use of ACP codes, so the time spent in important ACP discussions are properly compensated. (J Am Board Fam Med 2019;32:827-834.

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“…ACP may occur either outside of the clinician–patient relationship, or within it but not be captured by billing. Indeed, our own unpublished qualitative work has demonstrated that much ACP occurs in clinical settings without being billed 3 . Despite these limitations, because Medicare claims represent a standardized measure of ACP services in a very large and rich national dataset, it offers an advantage over previous studies that may have relied on small samples or nonstandardized measures of ACP.…”

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“…Kim et al 12 summarized the content of ACP clinical notes and compared with ACP billing code reimbursement in a tertiary care setting, one of the many places it would seem obvious to initiate these types of interactions. They reported very low use of ACP billing, suggesting that the reimbursement level continues to be insufficient to make ACP financially worthwhile.…”