Topics in Practice Management: Integrating Advance Care Planning into Practice

Advanced respiratory diseases progress over time and often lead to death. As their condition worsens, patients may lose medical decision making ability. Advance care planning (ACP) is a process in which patients receive information about their diagnosis and prognosis; discuss values, goals and fears; articulate preferences about life-sustaining treatments and end-of-life care; and appoint a surrogate medical decision maker. This process may result in written documentation of patient preferences, or appointment of a health care power of attorney (HCPOA). ACP discussions have multiple benefits for patients and their surrogate decision makers, including ensuring that care provided is aligned with a patient's goals and preferences; and decreasing stress, anxiety, and burden in surrogates. Time and provider comfort are often cited barriers to ACP, and so it may be necessary for clinicians to gain experience in conversations and identify the patients most likely to benefit from ACP discussions. Two new Current Procedural Terminology (CPT) codes, 99497 and 99498, have been recognized by the Centers for Medicare and Medicaid Services (CMS) as of January 1, 2016, intended to incentivize clinicians to engage in ACP discussions with their patients earlier and with more frequency. This article reviews the benefits and barriers to ACP in patients with advanced respiratory disease, and provides guidance on the use of the new CPT codes for reimbursement of these conversations.

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