Advance Care Planning provides a unique opportunity for a primary care provider (PCP) to discuss end-of-life decisions with their patients. The primary care setting and the relationship that is forged over time between a patient and their PCP provide the perfect opportunity for these conversations to be held in a trusted environment with a trusted confidant. Patients want to have these difficult conversations and they want to have them with someone who knows them and cares about them. They want to have these conversations with their PCP.
Advance Care Planning discussions take time. Often in a busy primary care practice, there is just not enough time to provide in-depth information about end-of-life choices. Luckily, this conversation can happen over time, in multiple appointments, and a provider can bill for their contributions.
I typically have end-of-life care discussions at a patient’s well visit. I find that there is time available during this visit to begin the process of delineating choices and finding out the patient’s views. It is a time when no decisions must be made, only contemplated. There is value in starting the conversation, even if the patient’s views and wishes are not completely clear. They can reflect on their thoughts and the conversation can be revisited. Typically, there are about 2-3 visits needed for discussion before acquiring signed documentation from the patient on their wishes. There may even be an opportunity to involve family members in a visit, especially ones who will be expected to make decisions on the patient’s behalf should they become incapacitated.
Even on that first visit, I provide a handout called the Advance Care Directives, in which a patient can choose what interventions they prefer should they become incapacitated. I have them take it home and discuss options with their family members. At their next visit, I inquire if they have had an opportunity to review the material. I answer questions and discuss their expectations. By the third visit, the patient usually returns the form, signed, and notarized. If they have not signed or notarized, this can be done in my office by one of our staff members who is a notary.
If the conversation can be difficult, then the coding part is easy. There are only 2 codes to bill advance care planning discussions.
| 99497 | First 30 minutes face-to-face with the patient, family member(s), and/or surrogate (minimum of 16 minutes documented) |
| 99498 | Each additional 30 minutes (Completion of ADs is not a requirement) |
To bill Advance Care Planning discussion, you must document that the Advance Care Plan was discussed with a patient, family member, caregiver, or surrogate. Documentation needs to include:
- The voluntary nature of the visit
- The explanation of advance directives
- Who was present
- The time spent discussing ACP during the face-to-face encounter
- Any change in health status or health care wishes if the patient becomes unable to make their own decisions
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