Clarifies documentation and coding requirements.

Medicare began reimbursing for advance care planning services (ACP) using CPT codes 99497 and 99498 in January 2016, and recently conducted an audit of such claims, finding that clinicians did not always comply with the documentation and time requirements. In response, the Center for Medicare and Medicaid Services (CMS) has issued a revised Advance Care Planning Fact Sheet. CMS has clarified that documentation must include the content of the discussion, the medical necessity of the discussion, the voluntary nature of the encounter, the content of any advance directives completed, the names and relationships of participants in the discussion, and the time spent in the encounter, ideally by noting the start and end time. The diagnosis(es) for which the ACP discussion is necessary should be included (or a well exam diagnosis in the case of an annual wellness visit.)

For more information, please see CAPC’s Optimizing Billing Practices Toolkit.

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