Advance Care Planning Billing Codes Are Rarely Used in Neurology
April 1, 2025
By Stacey Kusterbeck
The Centers for Medicare & Medicaid Services took an important step in 2016 by introducing billing codes for advance care planning. “Chronic neurodegenerative diseases are challenging illnesses that are progressive, disabling, and, ultimately, incurable. We wanted to assess how often these codes are used in neurology and whether they make a measurable impact,” says Gregory Brown, MD, PhD, a post-doctoral fellow at the University of California, San Francisco.
Brown and colleagues analyzed electronic health data from 92 institutions on patients ages 65 years or older diagnosed with multiple sclerosis, Parkinson’s disease, Alzheimer’s disease, or amyotrophic lateral sclerosis.1 The researchers compared emergency department visits and hospitalizations over a two-year timeframe, for patients with and without advance care planning codes documented. Some key findings were:
- Advance care planning billing codes were linked to decreased healthcare utilization for patients with neurological disease, particularly in the emergency department. There was a 20% to 30% decrease in emergency department visits for patients with advance care planning codes. The researchers also looked at the rates of emergency department visits and hospitalizations in the two years before and after a patient had advance care planning documented. Before the advance care planning documentation, patients’ utilization was increasing. After the advance care planning was documented, patients’ utilization decreased.
- Use of advance care planning codes was associated with a significant decrease in hospitalizations for Alzheimer’s disease patients.
- Advance care planning billing codes were used infrequently in neurological disease. “We expected low usage, but 2% to 3% is remarkably low. There clearly needs to be more awareness of the codes,” says Brown.
Many advance care planning conversations happen informally, and providers may not realize they can be reimbursed. Furthermore, these diseases are chronic, making it tricky for providers to find the optimal time to begin these discussions. “Early in a disease, there is a focus on maintaining function. Later in the disease, there are often cognitive impairments that make having these discussions challenging,” explains Brown.
Ethicists can work with physicians and administrators to make advance care planning routine practice. Standardized documents, training, and hospital-wide support systems are critical to ensuring these conversations happen consistently. “Building systems that support a culture of advanced care planning is essential. Ethicists are an important part of these initiatives,” says Brown.
Reference
1. Brown G, De Jesus S, Leboffe E, et al. Advance care planning billing codes associated with decreased healthcare utilization in neurological disease. J Healthc Manag. 2025;70(1):58-73.
The Centers for Medicare & Medicaid Services took an important step in 2016 by introducing billing codes for advance care planning. Researchers wanted to assess how often these codes are used in neurology.
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