Advance Care Planning Service ( ACP ) CPT Codes and Descriptions
CPT Codes
Billing Code Description
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 .
99798 Each additional 30 minutes . ( List separately in addition to code for primary procedure .
Important Advance Care Planning Service Billing Information :
· No limits to the number of times ACP can be reported for a given beneficiary in a given time period . The first 16 - 30 minutes are to be billed under 99497 and if the conversation is 46 minutes or more , both 99497 and 99498 can be billed .
· Billing of these codes is not limited to particular specialties , specific diagnosis , place of service and can be billed by any physician or non-physician authorized to independently bill Medicare .
· Codes can be billed on the same date of service ( or different date ) as most other Evaluation and Management ( E / M ) codes , as well as transitional care management services ( TCM ) or chronic care management services ( CCM ) or Annual Wellness Visit ( AWV ). It is important to indicate that the time spent on advance care planning was “ separate from and in addition to ” the other service ( s ).
· Appropriate documentation is required which includes an account of the encounter , noting the voluntary nature , who was present , the time spent , what forms were discussed , and the completed form when performed .
· Completion of an advance directive form such as Health Care Proxy , a Medical / Physician Orders for Life Sustaining Treatment ( MOLST / POLST ), a Living Will , DNR / DNAR / AND or a Durable Power of Attorney for Health Care are not a requirement for billing the service . The service is the explanation and discussion of the form .
References :
1 . Barazzetti G , Borreani C , Miccinesi G , Toscani F . What " best practice " could be in Palliative Care : an analysis of statements on practice and ethics expressed by the main Health Organizations . BMC Palliat Care 2010 ; 9:1 .
2 . Center to Advance Palliative Care ( CAPC ). Billing the Physician Fee Schedule for Advance Care Planning Services . August 2016 . https :// www . capc . org / search /? q = advance + care + planning + services +.
3 . Crooks , V ., Waller , S ., et al . The Use of Karnofsky Performance Scale in Determining Outcomes and Risk in Geriatric Outpatients . Journal Of Gerontology . 1991 ; 46 : M139-M144 .
4 . DesHarnais S , Carter RE , Hennessy W , et al . Lack of concordance between physician and patient : reports on end-of-life care discussions . Journal of Palliative Med 2007 ; 10:728 .
5 . Fried TR , Bradley EH , O ' Leary J . Prognosis communication in serious illness : perceptions of older patients , caregivers , and clinicians . J Am Geriatr Soc 2003 ;
51:1398 . 6 . Larson , Dale G ., Tobin , Daniel R ., End-of-Life Conversations . JAMA . 2000 ; 284 ( 12 ): 1573-1578 . doi : 10.1001 / jama . 284.12.1573 7 . McCusker M , Ceronsky L , Crone C , Epstein H , Greene B , Halvorson J , Kephart K , Mallen E , Nosan B , Rohr M , Rosenberg E , Ruff R , Schlecht K , Setterlund L . Institute for Clinical Systems Improvement . Palliative Care for Adults . Updated November 2013 . Available at : https :// www . icsi . org /_ asset / k056ab / PalliativeCare . pdf .
8 . Munday D , Petrova M , Dale J . Exploring preferences for place of death with terminally ill patients : qualitative study of experiences of general practitioners and community nurses in England . BMJ 2009 ; 339 : b2391 . 9 . Sepúlveda C , Marlin A , Yoshida T , Ullrich A . Palliative Care : the World Health Organization ' s global perspective . J Pain Symptom Manage 2002 ; 24:91 . 10 . Snyder CF , Dy SM , Hendricks DE , et al . Asking the right questions : investigating needs assessments and health-related quality-of-life questionnaires for use in oncology clinical practice . Support Care Cancer 2007 ; 15:1075 . 11 . Steinhauser KE , Christakis NA , Clipp EC , et al . Factors considered important at the end of life by patients , family , physicians , and other care providers . JAMA
2000 ; 284:2476 . 12 . The Palliative Performance Scale version 2 ( PPSv2 ) tool is copyright to Victoria Hospice Society and replaces the first PPS published in 1996 [ J Pall Care 9 ( 4 ): 26- 32 ]. It cannot be altered or used in any way other than as intended and described here . Programs may use PPSv2 with appropriate recognition . Available in electronic Word format by email request to judy . martell @ caphealth . org
13 . Weissman , M . D ., D , Meier , M . D ., D . Identifying Patients in need of a Palliative Care Assessment in the Hospital Setting . Journal of Palliative Medicine , 14 , 1-8 . DOI : 10 : 1089 / jpm . 2010.0347 .
This clinical guideline outlines the recommendations of Mount Carmel Health Partners for this medical condition and is based upon the referenced best practices . It is not intended to serve as a substitute for professional medical judgment in the diagnosis and treatment of a particular patient . Decisions regarding care are subject to individual consideration and should be made by the patient and treating physician in concert .
Original Issue Date : March 2017
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