Product Lines:
Advantage MD, Dual Eligible Special Needs Plans (D-SNP).

Measurement Period: January 1–December 31.

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

Improvement Notation:
Increased score indicates improvement.

Data Collection:

• Administrative.
• Supplemental.

Initial Population:

• Measure Item Count: Person.
• Age: 66 years of age and older as of the last day of the measurement period.
• Benefits: Medical.
• Continuous Enrollment: The measurement period.
• Allowable Gap: No more than one gap of ≤45 days during the measurement period. No gaps on the last day of the measurement period.

Definition:
Advance care planning: A discussion or documentation about preferences for resuscitation, life-sustaining treatment and end of life care.

Denominator:
Persons 66–80 years of age as of the last day of the measurement period who meet any of the following criteria:

• Advanced illness. Either of the following during the measurement period:
  • Advanced illness on at least two different dates of service.
  • Dispensed dementia medication.
• Frailty. An indication of frailty during the measurement period.
• Palliative care. Persons receiving palliative care or who had an encounter for palliative care any time during the measurement period.

Persons 81 years of age and older, as of the last day of the measurement period.

Numerator:
Advance care planning.
Evidence of advance care planning during the measurement period.

Best Practice and Measure Tips

Have a discussion or documentation about preferences for resuscitation, life-sustaining treatment and end of life care.

Measure Exclusions

Denominator Exclusions:

• Persons in hospice or using hospice services any time during the measurement period.
• Persons who died any time during the measurement period.

Numerator Exclusions:

For CPT Category II codes do not include:

• Laboratory claims (POS 81).
• CPT CAT II Modifier.

Measure Codes

Advance Care Planning

• CPT: 99483, 99497
• CPT- CAT- II: 1123F, 1124F, 1157F,1158F
• HCPCS: S0257
• ICD-10-CM: Z66 Do not resuscitate
• 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, 719238004, 719239007, 719240009, 3011000175104, 3021000175108, 3031000175106, 3041000175100, 3061000175101, 4921000175109, 87691000119105