VA Implementation
Workload capture and coding
The PPC approach can be applied in all types of clinical settings. Depending on the setting, there are strategies for how to build a clinic (if applicable), document the identification of priorities and recommendations to align care and capture workload.
Clinic Stop Codes: Are ways to designate the type of clinic that is providing a service. Occasionally, they can also designate the specific type of service(s) rendered in a clinic.
- Geriatric Problem Focused Clinic (318) primary stop code for a consultation clinics
- GRECC Clinical Demonstration Clinic (352) should only be utilized after discussion with your local GRECC Leadership
- Check with local Whole Health FIT expert and/or facility director if any WH stop codes are applicable. For more information regarding WH codes go to Patient Centered Care & Cultural Transformation (OPCC&CT) – Stop Codes – All Documents (sharepoint.com)
CPT Codes: Capture workload and VERA.
- Dependent on the type of encounter/person facilitating a PPC conversation
- For LIPs (MD/DO, ARNP, PA) utilize ‘new/est patient’ (99205) and additional time codes as appropriate (99417)
- Advanced Care Planning codes (99497 and 99498) can designate when a physician (or other qualified health care professional) and a patient and/or family member(s), and/or surrogate discuss the patient’s health care wishes if they become unable to make decisions about their care. CPT® code 99497 for the first 16 to 30 minutes. Use CPT® code 99498 for each additional 30 minutes.
- At a minimum, and as noted above, appropriate documentation must include the content and the medical necessity of the ACP-related discussion, the voluntary nature of the encounter, the content of any advance directives (along with completion of advance directive forms, when performed), the names of participants in the discussion; and the time spent in the face-to-face encounter. Best practice for the time documentation is to include the start and end time of the face-to-face conversation. Review the Centers for Medicare and Medicaid Services article for more information.
- For other Prescribing Licensed Independent Provider (LIP) s (Psychology, Licensed Clinical Social Work, Pharmacy, Physical Therapy, Occupational Therapy, Speech Therapy) can consider using the “Health and Behavior Assessment” code (96156) for seeing a patient and completing a PPC conversation
- Please consult with your local HIMS, VERA Coordinator and here for additional questions about coding related to PPC encounters and consultation
Through your PPC encounters/conversations, it’s vitally important to tag the appropriate health factor in order to capture the practice and dissemination of the PPC approach and Age Friendly Systems of Care. These health factors are found within the Patient Health Priorities CPRS Template and within the Age Friendly 4M’s Template.
Health Factors (HF): track a type of service provided. They generally do not amount to VERA capture but can help distinguish workload rendered/provided.
- Whole Health Age-Friendly and Patient Priorities Care Health Factors (HF)
- VA-WHS-AFHS-Identify Patient Priorities: applied to an encounter when patient priorities are assessed and documented
- VA-WHS-AFHS-Patient Priorities Follow-up : typically applied to an encounter or note when patient health outcome goal is identified and documented. Reflects the specific practice of PPC as a Whole Health Clinical Care approach, irrespective of when priorities were identified
- These can be or are embedded into Health Priorities Note template or added from the ‘encountering’ window. Check with your local CAC about how to include these HFs into your consult note if not using the Health Priorities Note
- For more information on Health Factors: Health Factors
- For utilization of HF (for tracking purposes): Whole Health Dashboard