Wiki ACP question

[lisafer360]

Can anyone tell me if the patient is REQUIRED to participate in ACP discussion. Patients daughter (DPOA) had a ACP discussion with my provider, but one of the patients(the mom) was asleep in another room and never was physically seen by the provider and the other patient(the dad) was asleep in the room in his wheelchair. I am having a hard time confirming the CPT definition means the patient must be one of the participants or if they are just one of the options of participants (the others being family and/or a surrogate).

HELP

 

[gwendolynmisevch]

Hi Lisa -
I see that the definition of the code allows for it:
"Advance care planning including the explanation and discussion of advance directives such as standard forms (with completion of such forms, when performed), by the physician or other qualified health care professional; first 30 minutes, face-to-face with the patient, family member(s), and/or surrogate." Supercoder explanation of code
I would feel comfortable billing this with POA present (particularly because the point of this visit is medical planning, and when a patient has a designated POA that person is court-appointed to make decisions for that patient's care). Also, and/or verbiage in the definition speaks to the "or" also - so as long as one of the participants can be defined as such - you are good to go!
Hope this helps!
Gwen

 

[lisafer360]

Thank you so much Gwen - I have read the definition 100 times and each time I read it with different inflection and pause with each comma and I still can't wrap my head around it. I have found at least 4 sources now that interpret it to mean that the patient doesn't have to be there and I was just hoping that one person like you would give their opinion as well. I really appreciate it.