Finally, Insurors are Developing Billing Codes for End-of-Life Medical Counselling

The NY TImes reported on August 31 that the American Medical Association (AMA) has created billing codes for doctors to use when they spend time with a patient discussing and explaining the options for medical treatment at the end of life.

The billing codes have been submitted to the Centers for Medicare and Medicaid Services (CMS) for consideration.  In the meantime, certain private health insurance companies, according to the NY Times article, are already  reimbursing doctors for these medical services.If CMS approves a new billing code for these services, it would be a benefit to both  patients and their families.

Ten years ago I had a client who was in a nursing home because he was so weak and frail. He was a widower in his late 80’s. He had congestive heart failure and had been in and out of the hospital about 8 times during the prior 2 years due to acute exacerbations. He was in an advanced stage of heart failure. His breathing was labored (he needed to be on oxygen), his muscles were very weak, and he could no longer lift himself up in bed or even stand. He was pale as a sheet and very thin. He was exhausted. His children had trouble accepting the idea that his heart was failing and that each return trip to the emergency room was more of a burden than a benefit to him. I met with him privately and he told me all these things. He said, “I’ve had a great life. Really. I am ready to go. I wish they would just let me go. My kids don’t get it. No one is asking me what I want. I just want to shut my eyes and be done.”

The family had initially contacted me because they were concerned about long-term nursing home planning. However it was heartbreakingly evident that the client himself was concerned about something else.

Our natural inclination is to treat every condition. These are difficult discussions. Debilitated patients and their families need to be able to sit down with the treating physician to get an understanding of what it would mean for the patient if they refused a feeding tube at the point that the patient was incapacitated and could no longer interact with the world around him, or if they refused further emergency rescue treatment and just remained in bed with palliative care.

All too often it is a non-physician hospital staff member who asks the patient or surrogate to sign off on advance directives or consent forms yet is unable to provide the medical explanations of the consequences. Also all too often families are being asked to make decisions related to use of life supports in haste, catching the doctor for a few minutes between patients, without the benefit of this important sit-down discussion.

I think it would be great if CMS approved a billing code for this crucial medical service. I hope that as their consideration is underway, they can inform the public that this is all about protecting the human dignity, choice and self-control of patients, and that it is not the creation of a “government funded death panel” as certain commentators so rudely described it.

For legal advice on end-of-life issues and other elder care matters, call 732-382-6070

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