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 1st 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
I work in a LTCH and when the patient is a true LTCH patient, I pull the clinical condition to the PDX with the palliative code as a secondary. If the patient is placed into hospice and is here solely for palliative care (typically because the family wants them to stay here), we discharge the patient from LTCH and readmit as a hospice patient with the Z code as PDX. We bill hospice, not Medicare, for this stay.Gail
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
I commit to leading the HIM corporate coding team so that we will provide consistent and accurate coding and billing information.
I audit services on the pro-fee side for Palliative services. I tell the Palliative providers to use the Z51.5 Encounter for Palliative care as their primary since this is the reason they are being called in. According to CPT rules, the first diagnosis reported should be the primary reason for the encounter. They should use the condition that initiated the Palliative care as secondary. Using the Z51.5 as primary differentiates their services from that of the Cardiologist, Pulmonologist, etc.
-Jennifer Phillips, RHIT, CPC, CRC, CEMC, CGSC
Corporate Compliance and Coding Support
704-512-5917 fax: 704-393-1026
Carolinas HealthCare System is Atrium Health
4425 Golf Acres Dr. Charlotte, NC 28208
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