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Counseling provided on symptom management, end of life decisions, and palliation (DEM)

CPT4 code

Name of the Procedure:

Counseling provided on symptom management, end of life decisions, and palliation (DEM)


This procedure involves comprehensive discussions between healthcare providers and patients or their families to address managing symptoms, making end-of-life decisions, and palliative care options. It aims to support patients with serious illnesses in improving their quality of life.


Counseling provided on symptom management, end-of-life decisions, and palliation addresses the physical, emotional, and psychological needs of patients facing serious or terminal illnesses. The goals are to alleviate symptoms, provide emotional support, assist with making informed end-of-life decisions, and ensure a comfortable and dignified quality of life.


  • Advanced or terminal illness
  • Uncontrolled symptoms (e.g., pain, nausea, breathlessness)
  • Emotional or psychological distress related to illness
  • Family and patient uncertainty about end-of-life care options
  • Desire for an improved quality of life through palliative care


  • No specific pre-procedure instructions or fasting required.
  • Review relevant medical history and current medications.
  • Diagnostics may include recent medical records and symptom assessment.

Procedure Description

  1. Initial Assessment: The healthcare provider meets with the patient and family to discuss their current condition, symptoms, and concerns.
  2. Symptom Management: Recommendations for managing symptoms through medications, therapies, or other interventions.
  3. End-of-Life Decisions: Discussion of advance directives, living wills, and patient preferences for end-of-life care.
  4. Palliation: Outlining a plan for palliative care services, including pain management, emotional support, and care coordination.

Tools usually include a private, comfortable setting for conversation, relevant medical records, and symptom assessment questionnaires. No anesthesia or sedation is required.


Typically lasts 1 to 2 hours, though follow-up sessions may be scheduled as needed.


Usually conducted in a hospital, outpatient clinic, or hospice center.


  • Physicians (e.g., palliative care specialists)
  • Nurses
  • Social workers
  • Counselors or psychologists

Risks and Complications

  • Emotional distress or discomfort during discussions.
  • Misunderstandings or miscommunications about patient wishes and care goals.


  • Improved symptom control and comfort.
  • Greater peace of mind and emotional support for patients and families.
  • Clear understanding and documentation of patient wishes.
  • Enhanced quality of life through comprehensive palliative care.


  • Immediate recovery; no physical recovery required.
  • Emotional or psychological follow-up might be needed.
  • Regular updates and adjustments to care plans based on symptom changes.


  • Standard medical treatment without specialized palliative care.
  • Hospice care for focused end-of-life care.
  • Psychiatric or psychological support for emotional and mental health.

Pros and cons of alternatives should be discussed, focusing on the comprehensive, multidisciplinary approach of palliative counseling versus more traditional, less integrated methods.

Patient Experience

Patients may initially feel anxiety or sadness during discussions but often experience relief and empowerment after formulating a clear plan. Comfort measures include ensuring a supportive environment and addressing any emotional reactions with appropriate counseling and support services.

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