AMA Releases CPT Codes for Advanced Care Planning Services
Recently, the American Medical Association (AMA) released new CPT (current procedural terminology) codes for advanced care planning services. The new release can be viewed as a stepping stone that could finally lead Medicare to consider reimbursement for end-of-life discussions between physicians and patients. This new initiative comes almost five years after similar proposals were taken out of the Affordable Care Act (ACA). The new medical billing codes were released in August 2014 and will be fully implemented towards the end of January 2015.
According to reports from The New York Times, some private insurers have already begun reimbursing physicians for the time spent with patients helping them to complete advance healthcare directives. With millions of baby boomers aging, there is increased interest in doctor-patient communication at present. The new code sets released will certainly help streamline reimbursement from private payers. One billing code released is for the initial 30 minutes of face-toface time spent with the patient, family member or surrogate to explain healthcare directives. Further, a 15-minute add-on code has also been released for additional 30 minutes of planning.
End-of-life Discussions – Patient Benefits
The release of the new CPT code sets indicates the growing significance of endof-life conversations and its potential benefits for patients. Generally, these discussions are not only patient centered, they are person centered. Patients diagnosed with certain conditions often have related fears and emotions. Therefore,
having detailed end-of-life discussions enables physicians to
understand specific goals and needs of patients and provide correct treatment modalities. In addition, these conversations provide opportunities for patients to think and express their wishes regarding the medical care they want to receive in different scenarios. This reduces emotional distress and can lead to better quality patient care. In most cases such conversations are open and timeconsuming as all nitty gritty details are discussed.
Decision on Reimbursement
Each year, the AMA submits numerous codes that are new, revised or deleted. Even though physicians understand and support the need for end-of-life conversations the final decision whether to provide health insurance reimbursement for the same is not yet made. The final decision whether to reimburse these services is up to the Centers for Medicare and Medicaid Service (CMS) and a decision is expected in November when they release the final 2015 physician fee schedule. It is estimated that about 50 million other Americans could be covered by Medicare if the recent proposal from the AMA is approved by CMS. At present Medicare utilizes a Healthcare Common Procedure Coding System code when a CPT code is not available. However, this does not include a payment policy and hence the need for CPT codes for reimbursement arises.
Recently, the Illinois State Medical Society submitted a new proposal to the AMA's CPT Editorial Panel clarifying the addition of new code for advanced care planning services. The proposal was accepted and a new code was created. This has led to an evaluation of the time and resources required to perform the services specified in the code. However, many private insurers provide adequate reimbursement for advanced care planning services.
With no CPT
codes in use, they have created their own codes that allow physicians to conduct, and bill for end-of-life discussions. It is now up to CMS to approve the CPT codes. In the prolonged process of decision making, CMS is expected to accept suggestions from hospitals, nursing homes and physician groups.
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