Cardiology Coding Alert

Question: We are learning more about advance care planning in the office, and we were wondering what qualifies as an advance directive?

California Subscriber

Answer: The 2017 CPT^® manual defines an advance directive as a legal document designating an agent to represent the patient, which contains the patient's written wishes for his treatment in the future, if he is unable to communicate his wishes.

Healthcare proxies, durable power of attorney for healthcare, living wills, and medical orders for life-sustaining treatment (MOLST) are some examples of written advance directives, per the 2017 CPT^® manual.

The patient can change his proxy at any time, according to Maggie M. Mac, CPC, CEMC, CHC, CMM, ICCE, AAPC Fellow, AHIMA-approved ICD-10 CM/PCS trainer, and president of Maggie Mac-Medical Practice Consulting in Clearwater, Florida.

Mac emphasizes the importance of the proxy/surrogate being completely aware of the patient's wishes.

"It's a matter of carrying out a patient's goals or values - their beliefs," Mac says. "You need to know whether or not they want to be maintained on life-sustaining equipment, and if they are not able to make that decision, do you have someone who can make those decisions, and are they aware of those decisions?"

Remember: An advance directive only goes into effect if the patient is "incapacitated and unable to communicate, regardless of age," according to 2014 CPT^® Assistant, Vol. 24, No. 12.