From AHRQ website
Do you consider do not resuscitate (DNR)?
Date Published: February 28, 2011
Date Updated: June 1, 2012
The AHRQ QI do not currently consider do not resuscitate (DNR) as either
a denominator exclusion or covariate in the risk-adjustment. We are
however currently evaluating three relatively recent data elements
related to hospice, palliative care and DNR. First, the UB-04 data
element Point of Origin added a data value of "F" (Transfer from a
Hospice Facility) in January 2010. Second, an ICD-9-CM diagnosis code
V49.86 (Do not resuscitate status) was added October 1, 2010. Finally,
the UB-04 data element Condition Code has a data value "P1" for "a DNR
order was written at the time of or within the first 24 hours of the
patient's admission to the hospital and is clearly documented in the
patient's medical record". The availability of HCUP data for 2010 will
allow us to evaluate empirically one or more of these potential data
elements alone or in combination as either an exclusion or covariate. As
with any other potential patient characteristic, the empirical
evaluation will focus on whether the characteristic is a mediator (and
therefore a covariate) or moderator (and therefore a stratification or
exclusion) of the quality of care.
Although there is currently an ICD-9-CM diagnosis code (V66.7) for
encounter for palliative care, the AHRQ QI do not incorporate the code
in QI calculations because it does not specifically identify hospice
care, can be applied at any time during a hospitalization (e.g., several
weeks or months after admission), and is not yet reliably reported. See
AHA Coding Clinic for ICD-9-CM, 3Q 2008, Volume 25(32):13-14: "This code
may be reported for any terminally ill patient who receives palliative
care, regardless as to when the decision is made. There is no time limit
or minimum for the use of this code assignment." See also AHA Coding
Clinic for ICD-9-CM, 1Q 1998, Volume 15(1):11: "Terms such as comfort
care, end-of-life care, and hospice care are all synonymous with
palliative care. These, or similar terms, need to be written in the
record to support the use of code V66.7."
In order for us to consider use of the V66.7 code, the coding guidance
will need to be clarified or 5th digits must be included. We encourage
professional societies with interest in this code to submit proposals to
clarify the guidance and/or the creation of additional, more specific
codes.
Cathy Seluke, RN, BSN, ACM, CCDS
Supervisor Clinical Documentation Compliance
MaineGeneral Medical Center
Augusta and Waterville, Maine
(207) 872-1796
Cathy.Seluke@mainegeneral.org
Date Published: February 28, 2011
Date Updated: June 1, 2012
The AHRQ QI do not currently consider do not resuscitate (DNR) as either
a denominator exclusion or covariate in the risk-adjustment. We are
however currently evaluating three relatively recent data elements
related to hospice, palliative care and DNR. First, the UB-04 data
element Point of Origin added a data value of "F" (Transfer from a
Hospice Facility) in January 2010. Second, an ICD-9-CM diagnosis code
V49.86 (Do not resuscitate status) was added October 1, 2010. Finally,
the UB-04 data element Condition Code has a data value "P1" for "a DNR
order was written at the time of or within the first 24 hours of the
patient's admission to the hospital and is clearly documented in the
patient's medical record". The availability of HCUP data for 2010 will
allow us to evaluate empirically one or more of these potential data
elements alone or in combination as either an exclusion or covariate. As
with any other potential patient characteristic, the empirical
evaluation will focus on whether the characteristic is a mediator (and
therefore a covariate) or moderator (and therefore a stratification or
exclusion) of the quality of care.
Although there is currently an ICD-9-CM diagnosis code (V66.7) for
encounter for palliative care, the AHRQ QI do not incorporate the code
in QI calculations because it does not specifically identify hospice
care, can be applied at any time during a hospitalization (e.g., several
weeks or months after admission), and is not yet reliably reported. See
AHA Coding Clinic for ICD-9-CM, 3Q 2008, Volume 25(32):13-14: "This code
may be reported for any terminally ill patient who receives palliative
care, regardless as to when the decision is made. There is no time limit
or minimum for the use of this code assignment." See also AHA Coding
Clinic for ICD-9-CM, 1Q 1998, Volume 15(1):11: "Terms such as comfort
care, end-of-life care, and hospice care are all synonymous with
palliative care. These, or similar terms, need to be written in the
record to support the use of code V66.7."
In order for us to consider use of the V66.7 code, the coding guidance
will need to be clarified or 5th digits must be included. We encourage
professional societies with interest in this code to submit proposals to
clarify the guidance and/or the creation of additional, more specific
codes.
Cathy Seluke, RN, BSN, ACM, CCDS
Supervisor Clinical Documentation Compliance
MaineGeneral Medical Center
Augusta and Waterville, Maine
(207) 872-1796
Cathy.Seluke@mainegeneral.org