Coding, Classification and Reimbursement

Inpatient Admission for Palliative Care

  • 1.  Inpatient Admission for Palliative Care

    Posted 11-22-2018 01:11
    Hello everyone!

    I'd like to ask help on one of the recent cases I have encountered regarding admissions for palliative care. Patient was admitted to the facility I'm coding due to CHF exacerbation with acute on chronic respiratory failure. Due to need of escalation of care patient was transferred to another facility in which during that stay patient'family decided on CMO/end-of-life care. Now the patient was transferred back to my facility for palliative care only as it was near in patient's family home (this is the encounter I am coding now). Patient was only maintained on Milrinone while waiting for other family members. Patient was discharged to Hospice facility.

    I have trouble deciding what PDX is most appropriate for this scenario.
    I referenced to the Coding Clinic below but is still undecided between CHF or Palliative care as PDX.

    Palliative care
    ICD-10-CM/PCS Coding Clinic, First Quarter ICD-10 2017 Pages: 48-49 Effective with discharges: March 13, 2017

    Can code Z51.5, Encounter for palliative care, be listed as the principal diagnosis or first-listed diagnosis when the reason for the encounter is to receive palliative care?

    Yes, assign code Z51.5, Encounter for palliative care, as principal diagnosis when palliative care is documented as the reason for the patient's admission. Code Z51.5 can be used in multiple care settings where it may be the first-listed diagnosis, but is typically not the principal diagnosis in the inpatient hospital setting. In many cases, it would be more appropriate as a secondary diagnosis, because it is not normally the reason for a hospital inpatient admission.

    The Official Guidelines for Coding and Reporting, Selection of principal diagnosis state, "The circumstances of inpatient admission always govern the selection of principal diagnosis. The principal diagnosis is defined in the Uniform Hospital Discharge Data Set (UHDDS) as that condition established after study to be chiefly responsible for occasioning the admission of the patient to the hospital for care." The UHDDS definition applies to all nonoutpatient settings (acute care, short term, long term care and psychiatric hospitals; home health agencies; rehab facilities; nursing homes, etc.) as well as to hospice services (all levels of care).

    In addition, based on the instructional note at category Z51 "code also the condition requiring care," assign a code for the underlying condition as an additional code. The "code also" note instructs that two codes may be required to fully describe a condition, but this note does not provide sequencing direction. Code Z51.5, may be listed either as principal diagnosis or as an additional diagnosis, depending on the circumstances of the admission.

    Karen Kay Gardose
    Medical Coder