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J Palliat Med. 2016 Dec;19(12):1249-1253. Epub 2016 Sep 28.

Top 10 Tips for Using Advance Care Planning Codes in Palliative Medicine and Beyond.

Author information

1
1 Main Line Health , Radnor, Pennsylvania.
2
2 Lankenau Medical Center , Wynnewood, Pennsylvania.
3
3 Acevedo Consulting, Inc. , Delray Beach, Florida.
4
4 Four Seasons Compassion for Life , Flat Rock, North Carolina.
5
5 Duke Palliative Care , Durham, North Carolina.
6
6 Duke Cancer Institute , Durham, North Carolina.

Abstract

Although recommended for all persons with serious illness, advance care planning (ACP) has historically been a charitable clinical service. Inadequate or unreliable provisions for reimbursement, among other barriers, have spurred a gap between the evidence demonstrating the importance of timely ACP and recognition by payers for its delivery.1 For the first time, healthcare is experiencing a dramatic shift in billing codes that support increased care management and care coordination. ACP, chronic care management, and transitional care management codes are examples of this newer recognition of the value of these types of services. ACP discussions are an integral component of comprehensive, high-quality palliative care delivery. The advent of reimbursement mechanisms to recognize these services has an enormous potential to impact palliative care program sustainability and growth. In this article, we highlight 10 tips to effectively using the new ACP codes reimbursable under Medicare. The importance of documentation, proper billing, and nuances regarding coding is addressed.

KEYWORDS:

advance care planning; billing and coding; community-based palliative care; inpatient palliative care; outpatient palliative care; revenue

PMID:
27682147
PMCID:
PMC5144846
DOI:
10.1089/jpm.2016.0202
[Indexed for MEDLINE]
Free PMC Article

Conflict of interest statement

Author Disclosure Statement Disclosures: Dr. Kamal has a consulting relationship with Pfizer and Insys. He has received research funding from the California Healthcare Foundation, Retirement Research Foundation, Cambia Foundation, Agency for Healthcare Research and Quality, National Institute for Nursing Research/National Institute of Health, and Michigan Oncology Quality Consortium/University of Michigan. Dr. Bull received research funding from the Center for Medicare and Medicaid Innovation.

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