Background In the US, new reimbursement for advance care planning (ACP) started on January 1, 2016. This study aims to describe patient and practitioner characteristics related to use of the new billing codes, including documentation of the ACP process and advance directives.

Methods Retrospective, cross-sectional analysis of the billing code 99497 from January 1, 2016 thru June 30, 2018 in outpatient visits in a large healthcare system. We describe patient-level and practitioner-level characteristics. We reviewed clinical documentation elements from a sample of patient visits from high- and low-utilizing practitioners.

Results Seventy-six practitioners used the ACP billing code in 3421 outpatient visits for 2884 patients. Patients were mean age 73 (range 20–104 years), 57% female, and 2% rural residing. 35% of patients had an advance directive on file. Mean number of billing encounters per practitioner was 45 (range 1–704). Visits occurred in primary care settings (family medicine, internal medicine, geriatric medicine) and two subspecialty clinics (neurology, cardiology). ACP was billed multiple times for 150 patients (5.2%), with a range of two to four visits. The average time between unique visits was 330 days. The most commonly documented topics were code status, POLST/MOST form, and surrogate decision maker. 28% of ACP documents on file were completed within seven days of the ACP billing visit.

Conclusions This is the first study to describe use of ACP billing codes in outpatient settings. Practitioners are using the ACP billing code mostly in primary care settings, among older adults, and occasionally multiple times.