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

September 2016

New Coverage Reflects Importance of Advance Care Planning 


Advance care planning is a crucial step to ensure 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, such as hospice or palliative care; discuss their preferences with them; and encourage them to prepare an advance directive.

It’s important to note, as well, that while hospice care is provided at the end of a terminal illness, palliative care be initiated at any point in the course of an illness, and can be provided along with measures aimed at treating the condition. Palliative care, or “comfort care,” is a team-based care model (involving doctors, nurses, and other professional medical caregivers) that assists patients and their families in managing the emotional and physical components of a serious or life-threatening illness.

Coverage for Advance Care Planning

Recognizing the importance of advance care planning, Harvard Pilgrim made a determination in July to cover the following services for dates of service beginning January 1, 2016:

  • 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)

This coverage is reflected in Harvard Pilgrim’s updated Evaluation and Management Payment Policy. For your patients interested in learning more about advance care planning, the National Institute on Aging offers a helpful website on this topic.

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PUBLICATION INFORMATION

Eric H. Schultz,
President and Chief Executive Officer

Robert Farias,
Vice President, Network Services

Annmarie Dadoly,
Editor

Joseph O'Riordan,
Writer

Kristin Edmonston,
Production Coordinator