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December 25, 1991

Reimbursement, Beneficence, and Advance Directives

Author Affiliations

Wellesley Hills, Mass

Wellesley Hills, Mass

JAMA. 1991;266(24):3424. doi:10.1001/jama.1991.03470240046022

To the Editor.  —The article on advance directives by La Puma et al,1 and the accompanying editorial by White and Fletcher2 emphasize the desirability of counseling for advance directives having taken place in the primary care setting. I agree that it is best to discuss the issues surrounding the limits of care before the need arises and when the patient and the family are not acutely stressed. However, in my experience, this usually takes a significant amount of time as various contingencies are discussed and evaluated.Therefore, I would strongly suggest that an "advance directives consultation" be given a separate category and Medicare billing number so that the proper time may be allotted and be reimbursable for this procedure. This should be documented in the patient's chart along with a completed and signed advance directives form and be subject to audit.Not only will this provide a necessary