Advanced Care Planning

1. Please define documentation requirements when billing advanced care planning (CPT 99497 and 99498).
   
   Answer: ACP codes may be used with or without a base E/M code on the same date of service, based on whether a separate and medically necessary E/M service has been performed.
   
   Documentation should reflect the provider’s discussion of this planning with the patient and an explanation of advance care directives, with or without completion of relevant legal forms. Since these codes are defined by time factors, the medical record should reflect time spent by the provider in this discussion.
    
2. What documentation is required for ACP visits?
   
   Answer: There are no specific documentation requirements for ACP; the record should reflect that the provider had this discussion with the patient and a summary of the patient’s responses and preferences. A standard form may be used to document these details.
    
3. May the ACP service be performed on an incident to basis by clinical or administrative office staff?
   
   Answer: Only the billing provider may perform the ACP service; it cannot be delegated on an incident to basis. The service entails a physician’s or NPP’s professional assessment of a patient’s mental and clinical status in making ACP decisions. While office staff may participate in the ACP documentation or discussion, the billing provider remains responsible for performing the key elements of the service.

Please see Helpful Reminders on Advance Care Planning for additional information.

Reviewed 10/8/2024