How to perform and bill an Advance Care Planning Conversation
by Katila Farley, RN CMOM
Advance Care Planning is an important conversation to have with your patient. Ideally, providers complete an Advance Care Planning discussion during the patient’s Medicare Annual Wellness Visit.
This is a great time to check in and ensure everything is up to date. And there are no frequency limits to the number of times that an ACP can be billed for a patient. As a reminder, for patients with insurance coverage, there is typically no cost incurred by the patient when an ACP conversation takes place during the Wellness Visit, but ACP adds a significant addition to the reimbursement of the AWV service with no added patient copay.
Additionally, there are reasons to have an ACP conversation outside of annual wellness visits - for example a patient has a stroke with a hospitalization. When they come in for their next visit, refreshing the ACP conversation would be wise.
If you’ve never completed an ACP conversation before here are the steps:
Review and record the health proxy (Decision Maker) and phone number
Decide upon treatment preferences for end of life care
Document decisions in the patient chart
If possible, obtain a copy of the living will and scan into EMR
Add billing codes (detailed below)
While the above are the requirements for an ACP conversation, let’s talk through some specifics.
Depending on the workflow in your clinic, if your patients have received a copy of the living will this gives you an open window to begin the conversation. As a tactical approach consider having your front desk give all your annual wellness visits a blank copy to review while waiting. Depending on the patient's overall health and diagnosis, you can determine how to approach the conversation. Normalizing the conversation is important in helping the patient feel comfortable.
Ask open-ended questions such as:
“Do you have any questions or concerns over selecting your treatment preferences”
“Do you have family that you can count on to follow your wishes”
“Tell me about your goals and future plans”
These open ended questions can create a relaxed conversation and allow you to work with the patient on their plans and expectations. It is wise to practice some scenarios to determine what works best for you individually. Each conversation will be unique.
Now lets take a look at the specifics on billing codes.
Here is a breakdown of the CPT codes needed to bill for the ACP services. The provider is eligible to bill during a face-to-face encounter. The codes are time-based in their complexity.
Remember - Advance Care Planning is an important part of quality care. With a little bit of intentionality, these conversations can be had and billed seamlessly within your workflow.
