Coding, Classification and Reimbursement

Hi Ayana

Since the removal of code Z51.5 Encounter for Palliative Care from the MCE list of Unacceptable Diagnoses in October 2017, I've seen some acute care scenarios for which I would assign use of Z51.5 as the principal diagnosis.  For example, 

Patient with metastatic breast cancer is receiving home hospice care services.  Oncology team is now admitting patient from home because the family is uncomfortable dealing with the patient's worsening pain, dyspnea and upper extremity edema.  Admission order for acute care inpatient unit written for comfort care only for hospice patient with established DNR/DNI order.    (I do realize that this scenario may have some concerns for medical necessity for an acute level of care.) 

Although Z51.5 Encounter for Palliative Care is not commonly assigned as the principal diagnosis in the acute care setting, the 1^st Quarter 2017 Coding Clinic, pp. 48-49, instructs to sequence Z51.5 as the principal diagnosis in some circumstances. Specifically, it states "Z51.5, Encounter for palliative care, is typically not assigned as the principal diagnosis in an acute care hospital setting because it is not normally a reason for admission in an acute care level of care.  However, if the reason for a hospitalization is palliative care, code Z51.5 may be sequenced first. 

For your first case, I would assign the code for the clinical condition (not the Z51.5) as the principal diagnosis.

Example 2, is less clear because the order for comfort care was not written until day two of the stay.

I am very interested in hearing when/if others are using Z51.5 Encounter for palliative care as a principal diagnosis for acute care inpatient admissions.

thanks

Hi Ayana

Since the removal of code Z51.5 Encounter for Palliative Care from the MCE list of Unacceptable Diagnoses in October 2017, I've seen some acute care scenarios for which I would assign use of Z51.5 as the principal diagnosis.  For example, 

Patient with metastatic breast cancer is receiving home hospice care services.  Oncology team is now admitting patient from home because the family is uncomfortable dealing with the patient's worsening pain, dyspnea and upper extremity edema.  Admission order for acute care inpatient unit written for comfort care only for hospice patient with established DNR/DNI order.    (I do realize that this scenario may have some concerns for medical necessity for an acute level of care.) 

Although Z51.5 Encounter for Palliative Care is not commonly assigned as the principal diagnosis in the acute care setting, the 1^st Quarter 2017 Coding Clinic, pp. 48-49, instructs to sequence Z51.5 as the principal diagnosis in some circumstances. Specifically, it states "Z51.5, Encounter for palliative care, is typically not assigned as the principal diagnosis in an acute care hospital setting because it is not normally a reason for admission in an acute care level of care.  However, if the reason for a hospitalization is palliative care, code Z51.5 may be sequenced first. 

For your first case, I would assign the code for the clinical condition (not the Z51.5) as the principal diagnosis.

Example 2, is less clear because the order for comfort care was not written until day two of the stay.

I am very interested in hearing when/if others are using Z51.5 Encounter for palliative care as a principal diagnosis for acute care inpatient admissions.

thanks

Hi Ayana

Since the removal of code Z51.5 Encounter for Palliative Care from the MCE list of Unacceptable Diagnoses in October 2017, I've seen some acute care scenarios for which I would assign use of Z51.5 as the principal diagnosis.  For example, 

Patient with metastatic breast cancer is receiving home hospice care services.  Oncology team is now admitting patient from home because the family is uncomfortable dealing with the patient's worsening pain, dyspnea and upper extremity edema.  Admission order for acute care inpatient unit written for comfort care only for hospice patient with established DNR/DNI order.    (I do realize that this scenario may have some concerns for medical necessity for an acute level of care.) 

Although Z51.5 Encounter for Palliative Care is not commonly assigned as the principal diagnosis in the acute care setting, the 1^st Quarter 2017 Coding Clinic, pp. 48-49, instructs to sequence Z51.5 as the principal diagnosis in some circumstances. Specifically, it states "Z51.5, Encounter for palliative care, is typically not assigned as the principal diagnosis in an acute care hospital setting because it is not normally a reason for admission in an acute care level of care.  However, if the reason for a hospitalization is palliative care, code Z51.5 may be sequenced first. 

For your first case, I would assign the code for the clinical condition (not the Z51.5) as the principal diagnosis.

Example 2, is less clear because the order for comfort care was not written until day two of the stay.

I am very interested in hearing when/if others are using Z51.5 Encounter for palliative care as a principal diagnosis for acute care inpatient admissions.

thanks

What is the patient is just being followed by Palliative Care during an acute stay? Palliative Care addresses quality of life and is not necessarily for end of life/hospice care.

Make that what if the patient is being followed by palliative care during an acute stay.

 

Terry Clark, RHIA, CCS

Director, Corporate Coding NTX

Baylor, Scott & White

(ph)817-637-6544

terry.clark@bswhealth.org

 

I commit to leading the HIM corporate coding team so that we will provide consistent and accurate coding and billing information.

 

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What is the patient is just being followed by Palliative Care during an acute stay? Palliative Care addresses quality of life and is not necessarily for end of life/hospice care.