5 things to know about billing for end-of-life care

Morgan Haefner - Print  | 

CMS recently accepted two Current Procedural Terminology reimbursement codes for conversations about end-of-life treatment, according to the American Medical Association.

Still, use of the codes remains low, according to a study published in JAMA Internal Medicine, which could indicate physicians face barriers to documenting end-of-life discussions.

Here, five key notes about billing for end-of-life care are discussed.

1. For an advance-care planning billing code to be reimbursable, physicians must hold the conversations in person and document them in an EHR.

2. CPT code 99497 is used for the first 30 minutes, paying about $86 for outpatient visits and $80 for inpatient visits. Thereafter, CPT code 99498 is used to pay $75 for each additional 30 minutes, according to the AMA.

3. In the JAMA study, researchers analyzed fee-for-service Medicare Part B claims in 2016 and part of 2017, and found billing rose from 1.9 percent of beneficiaries in 2016 to 2.2 percent in 2017. However, while advance-care planning billing grew, the study also found most physicians who are likelier to have end-of-life conversations with patients aren't using the codes.

4. The results varied significantly by state. Advance-care planning billing rates ranged from less than 1 percent in some states to 10.4 percent in others.

5. Specialty also affected billing rates for advance-care planning. Hospice and palliative care medicine saw the largest increases. While the share of physicians using an advance-care planning code at least once was 27.6 percent in 2016, the share grew to 35.9 percent in 2017.  

For the full JAMA study, click here.

For the AMA article, click here.

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