Understanding Advance Care Planning

In 1990, the Patient Self Determination Act became law. This law requires that patients are informed of their right to participate in medical decision making for end of life care. The intent of the law was to not only inform patients of their right but to provide them with education and assistance in making their wishes known. Unfortunately, the interpretation of the law has often been boiled down to asking patients on admission if they have a living will or advance directive and checking the appropriate box.

Ensuring that patients understand their right to receive the type of care they want at the end of life is everyone’s goal. In fact, on January 1, 2016, Medicare began paying for advance care planning. Advance care planning is so much more than just asking the question about advance directives or checking a box. It is about having a conversation of what is important to the patient and assisting them to put their wishes into words. In fact, according to a recent Modern Healthcare article, over 22,000 providers have received approximately $93 million in reimbursements for holding these conversations. If you are not billing for these important conversations, here are some tips to get you started:

  • Identify the right person in your practice to have these conversations with patients – ACP is billable using a team based approach
  • Ensure your identified professional is trained in holding the conversation – for more info on training check out our Advance Care Planning Certificate Course
  • Review the requirements of the two CPT codes – 99497 and 99498
  • To save your patient from co-pays and deductibles – set up a process to offer advance care planning along with your annual wellness visits

Please keep in mind that the procedure of advance care planning is about the conversation not about the form.

Author: Faith M Jones, MSN, RN, NEA-BC, Director of Care Coordination and Lean Consulting HealthtechS3

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