PCMS_Philadelphia_Medicine_Spring2018 - 22

p h i l a m e d s o c  .org

Feature continued

Reimbursement for Advance Care Planning
Effective January 1, 2016, Medicare will pay $86 for 30 minutes
of Advance Care Planning (ACP) in a physician's office and will pay
$80 for the same service in a hospital (CPT billing code 99497).
In both settings, Medicare will pay up to $75 for 30 additional
minutes of consultation (add-on CPT billing code 99498).
Advance care planning includes the explanation and discussion of
advance directives such as standard forms (with completion of such
forms, when performed), by the physician or other qualified health
care professional, face-to-face with the patient, family member(s),
and/or surrogate.
* CPT #99497
* Discussion and completion of forms (includes POLST)
* First 30 minutes
* CPT #99498
* Each additional 30 minutes
* No limits within a time period

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22 Philadelphia Medicine : Spring 2018

How did we implement the POLST form for in-patients?
At Jefferson Health - Northeast, the Ethics Committee
recognized undesirable heterogeneity in using the terms:
1) DNR, 2) DNI, 3) Withhold Ineffective Treatments, 4)
Withdraw Ineffective Treatments, 5) Comfort Care, and 6)
Designated Organ Donor Status. The Ethics Committee chose
the POLST form as the means of reducing that heterogeneity.
A POLST educational program with a mandatory computerbased training was designed and initiated for all clinical staff
by Nursing Education. A policy and procedure was approved
by Nursing P&P, Administrative P&P and then the Medical
Executive Committee.
The POLST program went live on February 1, 2017. For
a patient requiring any of the designations of 1) to 6) above,
the attending physician or designee discussed end-of-life issues
with the patient. Palliative care and hospice care services were
consulted as needed. The POLST form was completed and
the original given to the patient or surrogate as part of their
patient education materials. The POLST content was entered
into the EHR, allowing in-patient POLST status to be viewed
for every patient using the EHR with details in the order
set. Patients and staff have noted a reduction in confusion
at end-of-life care. Families have expressed improved staff
communication for end-of-life issues.
https://philamedsoc.org/ http://www.DVGRR.org http://www.DVGRR.org
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