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Advanced Care Planning (ACP)

HEDIS Measure

Advanced Care Planning (ACP)

Line of business: Medicare

Data Collection Method: Administrative

Measure Description

The percentage of adults 66–80 years of age with advanced illness, an indication of frailty or who are receiving palliative care, and adults 81 years of age and older who had advance care planning during the measurement year.

Numerator Compliance

Evidence of advance care planning during the measurement year.

Notation in the medical record of a discussion with a provider or initiation of a discussion by a provider during the measurement year.

Evidence of advance care planning must include one of the following:

  • The presence of an advance care plan in the medical record on or before December 31 of the measurement year.
  • Documentation of an advance care planning discussion with the provider and the date when it was discussed. The documentation of discussion must be noted during the measurement year.
  • Notation that the member previously executed an advance care plan. The notation must be dated on or before December 31 of the measurement year.

Best Practices

  • Discuss with members directives about treatment preferences Discuss with members the choice of having a surrogate who can make medical decisions should they be unable to make them (e.g., living will, health care power of attorney, health care proxy)
  • Offer written instructions regarding initiating, continuing, withholding or withdrawing specific life-sustaining treatment (e.g., Physician Orders for Life Sustaining Treatment [POLST], Five Wishes
  • Discuss with members the importance of having a Living will, Legal or Surrogate decision maker
  • Document in the medical record if a member declined to discuss advance care planning is considered evidence that the provider initiated a discussion and meets criteria
  • Document in the medical record that a conversations with relatives or friends about life-sustaining treatment and end-of- life care occurred

Quality Value Set Directory Coding Tips

Advance Care Planning

CPT

  • 99483
  • 99497

CPT-CAT-II

  • 1123F
  • 1124F
  • 1157F
  • 1158F

HCPCS

  • S0257

ICD10CM

  • Z66

SNOMED CT US Edition

  • 310301000
  • 310302007
  • 310303002
  • 310305009
  • 423606002
  • 425392003
  • 425393008
  • 425394002
  • 425395001
  • 425396000
  • 425397009
  • 699388000
  • 713058002
  • 713580008
  • 713600001
  • 713602009
  • 713603004
  • 713662007
  • 713665009
  • 714361002
  • 714748000
  • 715016002
  • 719238004
  • 719239007
  • 719240009
  • 3011000175104
  • 3021000175108
  • 3031000175106
  • 3041000175100
  • 3061000175101
  • 4921000175109
  • 87691000119105