Name of the Procedure:

Counseling and Discussion Regarding Advance Directives or End of Life Care Planning and Decisions, with Patient and/or Surrogate
HCPCS Code: S0257

Summary

This procedure involves a healthcare professional conducting a thorough conversation with a patient and/or their surrogate about end-of-life care planning, advance directives, and making informed decisions regarding future medical care. It's an essential step in ensuring that a patient's wishes are documented and respected.

Purpose

The purpose is to address issues related to end-of-life care, including the patient's preferences for medical treatments in various scenarios, designation of a healthcare proxy, and creation of legal documents such as living wills and advance directives. The goals are to ensure that the patient's wishes are clearly understood and documented and to provide peace of mind to both the patient and their loved ones.

Indications

• Patients with chronic, life-limiting illnesses.
• Elderly patients who wish to plan their end-of-life care.
• Patients facing major surgical procedures or critical care.
• Desire to clarify and document wishes regarding future medical treatments.
• Patients who want to appoint a healthcare proxy or establish advance directives.

Preparation

• No specific physical preparation is typically required.
• Patients may be encouraged to think about their healthcare values and preferences before the appointment.
• It can be helpful to bring any existing advance directives or living wills for review.

Procedure Description

1. The healthcare provider will begin by explaining the purpose and importance of advance care planning.
2. Open discussion about the patient’s values, medical preferences, and goals for care.
3. Explanation of medical terms and procedures that may be included in an advance directive.
4. Assistance with the legal documentation of the patient’s wishes, including living wills and designation of a healthcare proxy.
5. Discussion with the surrogate or family members if they are present.
6. Review and provide copies of the completed documents to the patient and appropriate healthcare institutions.

Duration

The discussion generally lasts between 30 minutes to an hour, depending on the complexity of the patient’s condition and preferences.

Setting

• Typically performed in a healthcare provider’s office.
• Can also be conducted in a hospital, outpatient clinic, or via telehealth.

Personnel

• Primary care physician
• Palliative care specialist
• Nurse practitioner or physician assistant
• Social worker (sometimes involved for additional support)

Risks and Complications

• There are no physical risks since it is a discussion-based procedure.
• Potential emotional distress when discussing end-of-life issues.
• Miscommunication or incomplete documentation might lead to the patient's wishes not being accurately followed.

Benefits

• Ensures the patient's wishes regarding end-of-life care are known and documented.
• Reduces stress and confusion for family members and medical staff during critical times.
• Helps prevent unwanted or unnecessary medical interventions.
• Empowers patients in their own healthcare decisions.

Recovery

• No physical recovery needed.
• Emotional support may be offered if the discussion evokes strong feelings.
• Patients are advised to review and update their advance directives regularly or as their medical condition changes.

Alternatives

• Not creating formal advance directives but verbally communicating wishes to family members (less reliable).
• Utilizing an online platform or legal services to create advance directives without healthcare provider's input (might lack medical guidance).

Patient Experience

• Patients might feel relief and peace of mind after formalizing their wishes.
• The discussion can be emotionally challenging but is handled with empathy and support.
• No pain management needed, though emotional comfort measures such as counseling may be provided if needed.