Have Physicians Embraced the Use of End-of-Life Billing Codes?

It’s been about a year since the Centers for Medicare and Medicaid Services (CMS) approved payment for voluntary end-of-life counseling as part of its 2016 Medicare physician fee schedule.

A recent article in Modern Healthcare suggests that many physicians are using the codes to have important end-of-life planning conversations with patients.

The codes (99497 and 99498) address matters relating to the explanation and discussion of advanced directives and include additional 30-minute time blocks when needed.

The article notes that nearly 23,000 providers billed Medicare for end-of-life planning appointments on behalf of nearly 575,000 beneficiaries last year, resulting in $43 million in Medicare reimbursements and another $50 million in patient deductibles and coinsurance. The rates CMS pays range from $80 to $86 for the first 30 minutes and another $75 for each additional 30 minutes.

Before implementing the new codes, CMS asked for and received about 725 public comments from a wide variety of interested parties including physicians and other healthcare providers, as well as chaplains, ethicists and advanced illness counseling companies. While most expressed support, some were concerned it might create financial incentives relating to termination of care.

CMS data indicates that a state’s population plays a part in the number of providers billing and the number of patients receiving care under the coding system. California topped the nation in the number of providers billing under the new codes with 2,314 billing on behalf of nearly 59,000 patients. It was followed by New York with 1,781 providers billing on behalf of nearly 44,000 patients. Texas and Florida followed with 1,471 and 1,368 providers respectively.

A year later, physicians say the new billing codes have allowed them to talk to patients about matters of importance to them. This allows patients to better determine if they should move forward with additional medical treatments that may extend their life, but not necessarily its quality.

Although the use of the codes appears straightforward, some physicians continue to seek clarity on when it is appropriate to bill using these codes; whether they can be used in conjunction with other codes billed on the same day, and with which other codes can they be billed.

The Health Law Offices of Anthony C. Vitale can assist healthcare professionals who need guidance on the use of these CPT codes. Call us at 305-358-4500 or send an email to info@vitalehealthlaw.com and let’s discuss how we might be able to help.

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The Health Law Offices of Anthony C. Vitale