Name of the Procedure:

Frailty and Advanced Illness Determination (HCPCS G2116)

Summary

This procedure involves identifying patients aged 66 years and older who have shown signs of frailty during the measurement period, as well as having either one acute inpatient encounter with a diagnosis of advanced illness, or two outpatient, observation, emergency department (ED), or nonacute inpatient encounters.

Purpose

The purpose of this procedure is to accurately identify elderly patients who are frail and suffering from advanced illnesses. By doing so, healthcare providers can tailor their treatment plans and allocate resources more effectively. The goal is to improve patient outcomes by providing targeted care that addresses both frailty and advanced illness.

Indications

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

Preparation

• Review medical history to confirm prior diagnoses of frailty and advanced illness.
• Gather and review any prior diagnostic tests and assessments related to the patient’s frailty and advanced illness.

Procedure Description

1. Patient Identification: Confirm patient age and history of frailty through medical records.
2. Encounter Review: Check for at least one acute inpatient encounter with a diagnosis of advanced illness or two qualifying outpatient, observation, ED, or nonacute inpatient encounters.
3. Data Collection: Document relevant findings and ensure accurate coding using HCPCS G2116.
4. Care Plan Development: Based on findings, develop or adjust the patient's care plan to address issues related to frailty and advanced illness.

Tools and equipment:

• Patient medical records
• Diagnostic tools for frailty assessment (e.g., mobility tests, cognitive assessments)

Anesthesia or sedation:

• Not applicable

Duration

This procedure typically takes a few hours, including review of medical records and patient verification.

Setting

The procedure can be conducted in various healthcare settings such as hospitals, outpatient clinics, or through telehealth services, depending on where the patient’s records are accessible.

Personnel

• Primary care physician
• Nurses
• Medical record specialists

Risks and Complications

There are minimal risks associated with this procedural identification. The main issue could be potential misidentification due to incomplete or inaccurate medical records.

Benefits

• Accurate identification of frail, elderly patients with advanced illness.
• Enables tailored care plans to improve patient outcomes.
• Better allocation of healthcare resources.
• Enhanced coordination of care among healthcare providers.

Recovery

• Not applicable as this is an identification procedure.
• Follow-up care plan and instructions will be provided based on the findings.

Alternatives

• Periodic comprehensive geriatric assessment.
• Utilization of other frailty indices and advanced illness markers.

Pros and cons:

• Alternatives may offer more detailed individual assessments but could be more time-consuming and resource-intensive.

Patient Experience

Patients might not directly feel the impact of the identification procedure itself but may experience improved care, attention, and customized treatment strategies following proper documentation and identification of their frailty and advanced illness status. Pain management and comfort measures will not typically be relevant for this identification procedure.