• Advance care planning: do’s and don'ts

    Discussions about end-of-life care can be uncomfortable for both patients and physicians, but they are key to respecting patients’ wishes to avoid aggressive care in their last days.

    The Centers for Medicare & Medicaid Services (CMS) began paying for advance care planning in 2016, and some private insurers have followed suit. CPT codes 99497 (for the first 16 to 30 minutes) and 99498 (for each additional 16 to 30 minutes) cover the time spent explaining and discussing advance directives face-to-face with patients, their family members, or surrogates as well as the time needed to complete forms.

    If you’ve been avoiding these difficult but important conversations, here are some do’s and don’ts to help you get started.



    Don’t wait until the very end of life to have the conversation, when the situation is often chaotic and stressful.

    Do initiate the discussion early, preferably before the patient is critically ill, when the conversation will be easier.

    Don’t call it an “end-of-life” discussion.

    Do call it “advance care planning.”

    Don’t enter these conversations cold.

    Do practice what you will say (for example, by role-playing with a colleague).

    Don’t delegate too much. CMS expects the billing physician or other provider to manage, participate, and meaningfully contribute to the provision of these services.

    Do involve others as appropriate (e.g., your staff can fill out the forms).

    Don’t skip the documentation.

    Do document that the conversation was voluntary, summarize what you discussed, explain advance directives, record the length of the conversation, and note who was present.

    Don’t rush the conversation.

    Do be prepared to spend as long as necessary to discover and record the patient's wishes.

    Don’t feel pressured to have this conversation with every patient.

    Do identify patients for whom this discussion is a priority. For example, ask yourself if you would be surprised if the patient died in the next year. If your answer is “no,” then have the talk.

    Don’t force the conversation if the patient isn’t ready or needs time to reflect.

    Do start the conversation by asking if the patient has any documents already prepared, has talked to anyone else about advance directives, and would be comfortable sharing how they feel.

    Read the full article in FPM: “Advance Care Planning: How to Have the Conversation You Want With Your Patients.”

    Posted on Nov 25, 2020 by FPM Editors

    Disclaimer: The opinions and views expressed here are those of the authors and do not necessarily represent or reflect the opinions and views of the American Academy of Family Physicians. This blog is not intended to provide medical, financial, or legal advice. All comments are moderated and will be removed if they violate our Terms of Use.