Watch billing limitations, coding rules for new advance care planning codes

Why This Topic Matters

Advance care planning is increasingly important in primary care, and correct reporting affects whether practices are reimbursed appropriately. Understanding the article helps readers evaluate workflow, documentation, and claim-billing considerations for these services.

Article Sections

1. Practice readiness and resources

   Discusses preparation for advance care planning conversations and the use of practice tools, forms, and external resources. It also highlights workflow considerations for collecting and storing patient information.

2. Clinical staffing and service delivery

   Covers who may provide advance care planning services and the general training and clinical context associated with these conversations. The section focuses on service delivery expectations rather than coding mechanics.

3. Adopt 4 successful coding, billing strategies

   Introduces the main billing and reporting topics addressed in the article, including time-based reporting, repeat billing considerations, and coordination with other visit types. It also mentions longer-duration reporting and related reimbursement issues.

4. Adhere to CPT timed-service rules

   Explains that the service follows standard timed-service principles and discusses the timing framework used for reporting. The section addresses general time thresholds in a billing context.

5. Explain why if you bill the service more than once

   Reviews the article's discussion of repeat reporting and the need for documentation when the service is reported again. The section stays focused on frequency and change-related billing considerations.

6. Bill ACP services with an E/M visit or annual wellness visit (AWV)

   Covers how the service may relate to evaluation and management visits, annual wellness visits, care management, and global periods. It also notes the article's discussion of preventive-service context.

7. Use add-on code 99498 for longer-duration services

   Addresses the article's discussion of reporting longer advance care planning encounters and related reimbursement concepts. The section focuses on extended service reporting.