Name of the Procedure:

Advanced Illness and Frailty Assessment (HCPCS G2099)

Summary

This procedure involves assessing patients 66 years of age and older for frailty during a specific period and identifying whether they have advanced illness through specified inpatient or outpatient encounters.

Purpose

The purpose is to identify older adults who have frailty and potentially advanced illnesses. The goal is to ensure these individuals receive appropriate care tailored to their specific physical condition and medical needs.

Indications

• Patients aged 66 and older
• At least one claim/encounter for frailty during the measurement period
• Either one acute inpatient encounter with a diagnosis of advanced illness or two outpatient, observation, emergency department, or nonacute inpatient encounters with advanced illness diagnoses

Preparation

Patients are advised to:

• Bring prior medical records and documentation of any current medications
• Undergo any required diagnostic tests such as blood tests or imaging, as advised by their healthcare provider

Procedure Description

1. Review the patient's medical history and any recent hospital or outpatient encounters.
2. Document the presence of frailty based on clinical assessment and diagnostic criteria.
3. Confirm the diagnosis of advanced illness through inpatient or outpatient encounters.
4. Compile the information in the patient's medical records for further medical decisions and care planning.
   • No specific tools or equipment are generally required.
   • Anesthesia or sedation is not necessary for this assessment procedure.

Duration

The duration can vary but typically takes between 30 minutes to 2 hours, depending on the comprehensiveness of the review and the patient's medical complexity.

Setting

This assessment is typically performed in a clinical setting, such as:

• Outpatient clinics
• Hospital-based practices
• Specialized geriatric assessment centers

Personnel

• Geriatricians or primary care physicians
• Nurses or nurse practitioners
• Medical assistants
• Health information technicians

Risks and Complications

• Risks associated with the assessment are minimal.
• Misinformation or incomplete medical records can affect the accuracy of the assessment.

Benefits

• Helps in identifying patients who need tailored care plans due to frailty and advanced illness.
• Facilitates timely and appropriate interventions, potentially leading to better health outcomes.

Recovery

Post-assessment:

• Patients will receive instructions if any further medical follow-up or tests are needed.
• No physical recovery time required from the assessment itself.

Alternatives

• Comprehensive Geriatric Assessment (CGA): A more exhaustive multidisciplinary approach.
  • Pros: Detailed, multidisciplinary input.
  • Cons: Time-consuming, resource-intensive.
• Standard primary care visits with specialist referrals as needed.
  • Pros: More straightforward and less formal.
  • Cons: Potentially less comprehensive in evaluating frailty and advanced illness.

Patient Experience

• The procedure involves careful review and conversation, which can help patients feel understood and well-cared for.
• The process is generally comfortable, with no invasive methods involved.
• Pain management is not needed as there is no painful aspect to the assessment.