Kim Peter, Daly Jeanette M, Berry-Stoelzle Maresi, Schmidt Megan, Levy Barcey T
From the Department of Family Medicine, University of Iowa Carver College of Medicine, Iowa City, IA (PK, JMD, MBS, MS, BTL); Department of Epidemiology, University of Iowa, College of Public Health, Iowa City, IA (BTL).
J Am Board Fam Med. 2019 Nov-Dec;32(6):827-834. doi: 10.3122/jabfm.2019.06.190121.
The Centers for Medicare and Medicaid Services released the final payment rules for reimbursement of advance care planning (ACP) effective January 2016. In its first year, 23,000 providers nationwide submitted 624,000 claims using the Current Procedural Terminology codes 99497 and 99498. The objectives of our study were to 1) assess the frequency of ACP codes used at a single academic tertiary care center in Iowa, 2) determine when and by whom the codes were used, and 3) summarize ACP clinical notes.
Using the electronic medical record data warehouse from a single tertiary teaching hospital and affiliated clinics, date of service, department where service was provided, provider name and type, patient medical record number, date of birth, and gender linked to the ACP codes 99497 and 99498 were collected. The content of ACP clinical notes were reviewed and summarized. Study period was from January 1, 2016 through September 19, 2018.
During the 33 months, code 99497 was used 17 times and code 99498 was never used. Code 99497 was successfully reimbursed 4 times.
Charges were not reimbursed if the ACP visits did not meet the minimum time requirement or were conducted by an individual not considered a qualified health care professional per Medicare rules.
ACP codes 99497 and 99498 were very rarely used at this tertiary care center during the initial 33-months after the Medicare rules went into effect. Interventions are needed to promote the use of ACP codes, so the time spent in important ACP discussions are properly compensated.
医疗保险和医疗补助服务中心发布了自2016年1月起生效的预先护理计划（ACP）报销最终支付规则。在第一年，全国有23,000名提供者使用现行程序术语代码99497和99498提交了624,000份索赔申请。我们研究的目的是：1）评估爱荷华州一家学术性三级医疗中心使用ACP代码的频率；2）确定代码的使用时间和使用者；3）总结ACP临床记录。
利用一家三级教学医院及其附属诊所的电子病历数据仓库，收集与ACP代码99497和99498相关的服务日期、服务提供科室、提供者姓名和类型、患者病历号、出生日期以及性别。对ACP临床记录的内容进行了审查和总结。研究期间为2016年1月1日至2018年9月19日。
在这33个月期间，代码99497使用了17次，代码99498从未使用过。代码99497成功报销了4次。
如果ACP就诊未达到最短时间要求，或者由医疗保险规则认定的非合格医疗保健专业人员进行，则费用不予报销。
在医疗保险规则生效后的最初33个月里，该三级医疗中心极少使用ACP代码99497和99498。需要采取干预措施来促进ACP代码的使用，以便重要的ACP讨论所花费的时间得到适当补偿。
