2023 Advance Care Planning – Post Test

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Question 1 of 10

1. Question
1. The session noted several things that needed to be documented with the Advance Care Planning note for appropriate billing. These include (choose all that apply):
- a. The time spent in discussion that day with the patient related to ACP
- b. Notation of the patient’s wishes and wants regarding Advance Directives
- c. Any “next steps” taken away from the ACP discussion
- d. Documenting at least Moderate MDM in the encounter
Question 2 of 10

2. Question
2. Which of the following is FALSE with respect to Advance Care Planning?
- a. There are no frequency limits as long as decisions are being made relative to ACP
- b. Form completion time counts, if done the same day
- c. Critical care billing and ACP are allowed on same day
- d. It is OK to bill ACP in the same month as CCM, but the time allotted for ACP should not be counted as part of the CCM
Question 3 of 10

3. Question
3. You perform Advance Care Planning ((ACP) with one of the Medicare Annual Wellness Visits (initial/subsequent) or the IPPE, and you add a modifier -33 to the ACP code. How is the billing of the MWV and ACP performed?
- a. The MWV remains co-insurance and deductible waived, the ACP is co-insurance and deductible applied.
- b. The MWV remains co-insurance and deductible waived, the ACP cost is reduced by 33% due to the modifier.
- c. The MWV remains co-insurance and deductible waived, the ACP is co-insurance and deductible waived due to the modifier.
- d. Both MWV and ACP are billed the same with or without the modifier. It is only applied for data tracking for quality metrics
Question 4 of 10

4. Question
4. You do a 99213 encounter and spend an additional 12 minutes discussing end of life issues with the patient. She wishes to go home and call you to make sure her daughter is on board with her wishes. That call with you occurs over lunch today for an additional 14 minutes. You can optimally bill (assuming documentation supports)
- a. 99214 due to E/M plus time
- b. 99497 because it was under 30 minutes
- c. 99498 because if was above the 16 minute threshold of 99497
- d. 99213 + 99497 because we spent more than 16 (of the required 30) minutes dealing with ACP-specific issues.
Question 5 of 10

5. Question
5. The same encounter above occurs, but you also spend an additional 22 minutes reviewing the Advance Directives on the chart and reviewing other forms after the discussion with the family earlier that day (total time in ACP is 48 minutes). The billing now can be
- a. The 99211 as this qualifies as a “form completion” fee
- b. Bill the ACP lower code and CCM
- c. 99213 + 99497 (first 30’) + 99498 (16+ minutes of the next 30’)
- d. 99214
Question 6 of 10

6. Question
6. The discussion with a patient in delivery of ACP services (choose ALL that are correct)
- a. Can be billed incident-to by clinical staff under the direction of the physician
- b. Can only be billed once each month
- c. Has no restrictions on the number of times billed, but each encounter should document the essence of the discussion to show the need for the visit,
- d. Must meet the level of moderate or high medical decision making to be billable
Question 7 of 10

7. Question
7. During the Public Health Emergency (PHE)
- a. The co-insurance for the Advance Care Plan (ACP) has been waived
- b. The co-insurance for the ACP has been reduced by 33%
- c. The -33 modifier has been changed to “–PHE” to allow better tracking on claims
- d. Audio/video and audio-only modalities are allowed to perform ACP in addition to the face-to-face encounter
Question 8 of 10

8. Question
8. At least 16 minutes of time must be spent to compliantly bill for the initial ACP service (99497, first 30 minutes). The time to perform which of the following would be allowed to count with respect to ACP billing?
- a. The time taken for form completion, same day
- b. The time spent on chronic disease management separate from ACP discussions
- c. The time spent by you on a call to the patient’s Power of Attorney over lunch to share your understanding of the patient’s wishes
- d. The time after work today reviewing all the lipid labs that returned from the visit.
Question 9 of 10

9. Question
9. Regarding the ACP end of life discussion (EOL), patients
- a. Want this discussion and perception of the physician was found to be improved when EOL topics were addressed
- b. Feel hopeless after having EOL discussions with their PCP
- c. Have more serious depressive episodes in patients after ACP discussions with their PCP
- d. Are prone to escalate cost of fruitless care treatment options after ACP discussions with their PCP
Question 10 of 10

10. Question
10. Physicians shy away from EOL discussions for several reasons noted in the session. Reasons for this hesitancy were
- a. A perceived lack of competence on EOL discussions,
- b. Struggles in choosing the best time for patient readiness to discuss EOL planning
- c. A fear of destroying hope with the patient’s perception of disease burden
- d. A history of repeated failed attempts at having ACP discussions with patients.

2023 Advance Care Planning – Post Test

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