CurrentHighmark Blueshield NenyPolicy N/A

Advance Directives — Coverage Criteria

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This policy governs offering and documenting advance directives for patients (routinely for those aged 65 and older and upon request for younger patients) and specifies which life-sustaining treatments may be addressed. It applies to clinical staff responsible for patient care and medical record documentation.

Policy Summary

PayerHighmark Blueshield Neny

PolicyAdvance Directives — Coverage Criteria

Policy CodePolicy N/A

Change TypeNo material changes

Effective DateN/A

Next Review DateN/A

Key ActionDocument in the progress notes that a discussion of advance directives occurred and note their existence on the front of the medical record.

SourceLink

POLICY UPDATE CHANGES

No material clinical or coverage changes in this revision.

age 65+patients systematically offered advance directives

younger on requestpatients <65 offered advance directives if they request

6example procedures listed that may be included

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CurrentHighmark Blueshield NenyPolicy N/A

Advance Directives — Coverage Criteria

Customize your policy alerts

Sign up for all Highmark Blueshield Neny policy alerts

Know when Highmark Blueshield Neny releases new policies or updates existing guidance.

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Policy Summary

PayerHighmark Blueshield Neny

PolicyAdvance Directives — Coverage Criteria

Policy CodePolicy N/A

Change TypeNo material changes

Effective DateN/A

Next Review DateN/A

Key ActionDocument in the progress notes that a discussion of advance directives occurred and note their existence on the front of the medical record.

SourceLink

POLICY UPDATE CHANGES

No material clinical or coverage changes in this revision.

age 65+patients systematically offered advance directives

younger on requestpatients <65 offered advance directives if they request

6example procedures listed that may be included

Offering Advance Directives

Advance directives should be offered when the following patient conditions apply:

Offer conditions: Offer advance directives to all patients aged 65 and older OR to any patient younger than 65 upon request.

logical OR between age-based offering and patient request

No explicit exclusions are stated in this policy.

The document does not specify any conditions or services that are considered not medically necessary.

Provider Actions & Requirements

Prior Authorization

Prior authorization

No prior authorization requirements specified for advance directives or related documentation in this policy.

Step Therapy

Step therapy

No step therapy requirements specified for advance directives or related documentation in this policy.

Documentation Required

Required documentation

Documentation that a discussion of advance directives occurred between the patient and physician must appear in the progress notes. The advance directives should also be noted on the front of the medical record. This includes offering advance directives to all patients age 65 and older and to any patient younger than 65 upon request, and noting patient preferences about procedures such as surgery, respiratory support, cardiopulmonary resuscitation, renal dialysis, and artificial nutrition and hydration.

Billing Rule

Billing/denial triggers

Not applicable — no billing or claim denial triggers specified related to advance directives in this policy.

Background

Advance directives allow patients to express their preferences about receiving or discontinuing specific medical treatments or procedures if they become incompetent and are either terminally ill or in a persistent vegetative state. The policy specifies that the opportunity to create a set of advance directives will be offered to all patients aged 65 and older and to any patient younger than 65 upon request. Examples of interventions that may be addressed in an advance directive include, but are not limited to, surgery, respiratory support (mechanical), cardiopulmonary resuscitation, renal dialysis, and artificial nutrition and hydration.

Definitions

Advance directives — definition and key points

DefinitionPatient instructions expressing intentions about receiving or having discontinued specific medical treatments or procedures if the individual becomes incompetent and either terminally ill or in a persistent vegetative state.

Who should be offeredOffered to all patients aged 65 and older.

Younger patientsAlso offered to any patient younger than 65 upon request.

Typical interventions that may be addressedExamples include surgery; respiratory support (mechanical); cardiopulmonary resuscitation; renal dialysis; artificial nutrition and hydration.

Documentation requirementA record that a discussion of advance directives occurred must appear in the progress notes and the existence of advance directives must be noted on the front of the medical record.

Policy Summary

PayerHighmark Blueshield Neny

PolicyAdvance Directives — Coverage Criteria

Policy CodePolicy N/A

Change TypeNo material changes

Effective DateN/A

Next Review DateN/A

Key ActionDocument in the progress notes that a discussion of advance directives occurred and note their existence on the front of the medical record.

SourceLink

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Advance Directives — Coverage Criteria

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Advance Directives — Coverage Criteria

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Coverage Criteria — Advance Directives

Provider Actions & Requirements

Background

Definitions