Advance care planning is the process of planning for future medical treatment in the event that patients are unable to make their own decisions. It ensures that patients receive healthcare services that are consistent with their personal wishes, culture, goals, and values.
There are numerous benefits to advance care planning. First and foremost, it enables healthcare professionals to conduct structured, meaningful conversations with patients about their personal preferences regarding medical treatment, which promotes patient-centered care. It also allows patients and their families to make informed medical decisions and supports the delivery of high-quality care and more effective utilization of healthcare services.1 Finally, it relieves loved ones of the emotional burden of making end-of-life decisions for the patient.1
Advance care planning is not a one-time event—it is an ongoing conversation between the provider, patient, and family that evolves over time as the patient ages or there is a change in his or her health status. It is not just for elderly or chronically ill patients. Young, healthy adults should also express their preferences in case they become incapacitated due to an unexpected injury or illness.
There are 4 key facets of advance care planning: advance directives, healthcare power of attorney, portable medical orders, and voluntary advance care planning.
“Advance directive” is a general term that can be used to describe various documents, such as a living will or healthcare power of attorney. It is important to understand that these documents are state-specific, and each state may use different terms to describe different forms. A living will, which may also be called an advance directive, healthcare directive, or instruction directive, is a legal document that allows the patient to document his or her wishes in writing for end-of-life medical treatment. The patient may document preferences regarding specific healthcare decisions, such as cardiopulmonary resuscitation, tube feeding, palliative care, and organ donation.
A healthcare power of attorney allows the patient to select a family member or trusted individual who can make medical decisions in the event the patient is incapacitated and unable to do so. It is important for the patient to have a conversation with this individual regarding specific desires to avoid any misunderstandings.
Portable medical orders summarize the preferences of an individual regarding life-sustaining treatment as documented in an advance directive. These orders follow the patient from one healthcare setting to another and communicate his or her wishes to all providers, including first responders, during a medical emergency.
Depending on the state, a portable medical order may be called any of the following2:
- MOLST (Medical Orders for Life-Sustaining Treatment)
- POLST (Physician Orders for Life-Sustaining Treatment)
- MOST (Medical Orders for Scope of Treatment)
- POST (Physician Orders for Scope of Treatment)
- TPOPP (Transportable Physician Orders for Patient Preferences)
- Out-of-hospital Do Not Resuscitate (DNR) Orders.
Voluntary advance care planning is a face-to-face service between a Medicare physician (or other qualified professional) and a patient to discuss the patient’s healthcare wishes if he or she becomes unable to make decisions about medical care.3 This conversation may or may not include the completion of advance directive forms.
Medicare began paying for advance care planning in 2016. Other insurance payers may reimburse for this service; however, it is subject to individual policies. Therefore, providers should check with their specific carrier regarding coverage ahead of time.
There is no limit to how many times a provider can report advance care planning for a patient. However, documentation must reflect the change in the patient’s health status or preferences. Advance care planning may be performed in a facility or non-facility setting.
There are 2 Current Procedural Terminology (CPT) codes for advance care planning:
- 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 healthcare professional; first 30 minutes, face-to-face with the patient, family member(s), and/or surrogate.
- 99498. 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 healthcare professional; each additional 30 minutes (list separately in addition to code for primary procedure).3
Healthcare Common Procedure Coding System
Advance care planning services are subject to deductible and coinsurance unless performed during a Medicare Annual Wellness Visit (Healthcare Common Procedure Coding System codes G0438 and G0439).3 Since there is no cost share during an annual wellness visit, this is an opportune time to document changes and update the advance care plan with the patient.
CPT Category II
There are also 2 CPT Category II codes that can be submitted to report advance care planning. CPT Category II codes are utilized for supplemental tracking of quality performance only, do not generate a charge for the patient, and are not reimbursable.
The reportable CPT Category II codes are:
- 1123F (Advance care planning discussed and documented). Advance care plan or surrogate decision-maker was documented in the medical record.
- 1124F (Advance care planning discussed and documented in the medical record). Beneficiary/patient did not wish to, or was unable to, provide an advance care plan or name a surrogate decision-maker. If a patient’s cultural and/or spiritual beliefs preclude a discussion of advance care planning, submit this CPT Category II code.4
Advance care planning is widely recognized as an effective way to facilitate decision-making and promote high-quality care at the end of life. It should be an ongoing process in which patients, families, and healthcare providers reflect on the patient’s goals, values, and preferences, and discuss how they should influence current and future medical care. Providers should encourage individuals to participate in advance care planning discussions, which can lead to peace of mind for patients and their loved ones while honoring their choices regarding important healthcare decisions.
- ACP Decisions. 19 evidence-based benefits of advance care planning. October 15, 2020. https://acpdecisions.org/19-evidence-based-benefits-of-advance-care-planning/. Accessed April 26, 2021.
- The Office of the National Coordinator for Health Information Technology. Portable medical orders for life-sustaining treatments. www.healthit.gov/isa/uscdi-data/portable-medical-orders-life-sustaining-treatments. Accessed June 16, 2021.
- Centers for Medicare & Medicaid Services. Medicare Learning Network fact sheet: advance care planning. October 2020. www.cms.gov/outreach-and-education/medicare-learning-network-mln/mlnproducts/downloads/advancecareplanning.pdf. Accessed June 8, 2021.
- Centers for Medicare & Medicaid Services Innovation Center. Bundled Payments for Care Improvement Advanced Model Quality Measures fact sheet: advance care plan. September 2019. https://innovation.cms.gov/files/fact-sheet/bpciadvanced-fs-
or%20was%20unable%20to%20provide%20an%20advance%20care. Accessed June 8, 2021.