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In "Resuscitating Advance Directives," Lo and Steinbrook¹ write, "Furthermore, physicians who discuss advance care planning can bill for their time using evaluation and management codes and documenting the time spent counseling the patient." Would that it were as fair in practice as it sounds in theory. There are 2 problems with this statement.

In most circumstances no reimbursement is collected for counseling regarding advance directives. Most patients for whom a physician would spend time counseling on advance directives are also seeing that physician for evaluation and management of medical illnesses, generally the very conditions which bring end-of-life discussions to the fore. Thus, a patient for whom advance directive counseling is pertinent will also require assessment and management of, for example, his or her congestive heart failure, diabetes, and nausea. The billing for this patient maximizes out at $99 214 for the medical care, and no additional reimbursement is available for the . . . [Full Text of this Article]

AUTHOR INFORMATION
Christine Sinsky, MD

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RELATED ARTICLE

Resuscitating Advance Directives
Bernard Lo and Robert Steinbrook
Arch Intern Med. 2004;164(14):1501-1506.
ABSTRACT | FULL TEXT