Harvard Pilgrim Health Care Home
  HPHConnect
 
  Learn more.
  Sign up for HPHConnect.
Medical Management
E-Transactions
HPHConnect
Pharmacy
For Your Patient
News Center
Network Matters
Newsletter Archives
Newsletter Registration
Newsroom
Office Support
Products
Provider Manual
Medicare Advantage
Research & Teaching
Resources & Links
 
Print    Text Size

Network Matters
News and Information for the
Harvard Pilgrim Health Care Network

April 2019

Advance Care Planning Coverage (99497 & 99498)


Advance care planning is a crucial step to ensuring that patients get the medical care they want when they are unable to speak for themselves due to illness or injury. Without clear end-of-life conversations, family members may be burdened with worry that they will make a choice their loved one would not have wanted, and patients may receive more aggressive treatment than they would have chosen. Conversely, early and frequent conversations among providers, patients, and families about their preferences for end-of-life care can provide the patient with peace of mind that his or her medical wishes will be followed, ease the burden on family members, and prevent unwanted treatment.

While clinical research has found that advance care planning can improve the quality of life for patients with serious, progressive, and potentially fatal conditions, patients rarely initiate these conversations with their doctors and family members. As a result, it’s important for physicians to educate patients about advance care options and encourage them to prepare an advance directive.

Coverage for advance care planning

Recognizing the importance of advance care planning, Harvard Pilgrim encourages you to use the following codes to support these important conversations:

  • 99497 — Advance care planning including 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; first 30 minutes, face-to-face with the patient, family member(s), and/or surrogate
  • 99498 — Advance care planning including 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; each additional 30 minutes (List separately in addition to code for primary procedure)

If you or your patients are interested in learning more about how to start the advance care planning conversation, you can find more resources here. Additionally, the National Institute on Aging offers helpful information and resources for patients on the Advance Care Planning page on their website, and the website for National Healthcare Decisions Day (an annual nationwide initiative focused on providing clear, concise, and consistent information on health care decision-making and advance care planning to both the public and providers/facilities) offers helpful resources and suggestions for how providers can take part in this year’s April 16 event.

Email this article to a colleague   


Network Matters Archives

Download printer-friendly version

HPHCURRENT EVENTS

Improved Functionality, New Design for HPHConnect Referrals

Submitting Claims for Fidelity, Sedgwick, and Nielsen Members

Shared Decision-Making Tools for Members and Providers

CLINICIAN CORNER

NICU Program with ProgenyHealth Begins June 1

Emergency Department Overuse

Advance Care Planning Coverage (99497 & 99498)

Complex Case Management Services

Disease Management Programs Reinforce Physician Treatment Plans

Prior Authorization Required for Ilumya

Prior Authorization for Cutaquig and Libtayo

Prior Authorization Required for Onpattro

Alcohol and Drug Use Disorder: Treatment and Helpful Resources

Pharmacy and Therapeutics Committee Meeting Update

Specialty Pharmacy Program Updates

OFFICE ASSISTANT

Correct Use of Modifiers 58, 78, and 79

PUBLICATION INFORMATION

Robert Farias,
Senior Vice President, Corporate Network Strategy

Annmarie Dadoly,
Editor

Joseph O'Riordan,
Writer

Kristin Edmonston,
Production Coordinator