Billed Advance Care Planning Conversations by a Growing Palliative Care Team: Insights from a Five-Year Review

Background: In 2015, two Current Procedural Terminology codes were introduced for advance care planning (ACP), enabling a palliative care (PC) team to track its ACP conversations. Objective: To examine billed ACP conversations over five years. Design: Retrospective analysis. Setting/Subjects: PC patients in a large Midwest U.S. health care system. Measurements: Demographic information, service location, ACP codes. Results: From 2017 to 2021, total billed ACP conversations and PC clinicians increased from 381 to 5718 and 27 to 41, respectively. Of 10,307 unique patients from 17,091 billed conversations, the majority were female (52%), White (74%), and non-Hispanic (96%); 32% of in-state patients resided in areas of health care underutilization. Conversations occurred mostly (81%) in the hospital setting. A single 30-minute code was used in 81% of conversations. Conclusion: Integration of ACP billing into a growing PC team across five years saw a rise in billed ACP conversations and predominance of certain patient groups.