palliative care
This is more of a core measure question, but hopefully someone knows or has resources. We were told that a patient that has been made 'palliative care' will not be excluded from core measure data unless the order was on admit or up to the first day. After that, they cannot be excluded. Anyone?
Christine Reed, RN, BSN
Clinical Documentation Specialist
CDIP Team Leader
Elkhart General Hospital
Phone: (574) 389-5665
Pager: (888) 301-9402
Please note my new e-mail address:
Email: careed@beaconhealthsystem.org
Christine Reed, RN, BSN
Clinical Documentation Specialist
CDIP Team Leader
Elkhart General Hospital
Phone: (574) 389-5665
Pager: (888) 301-9402
Please note my new e-mail address:
Email: careed@beaconhealthsystem.org
Comments
Please see attached information:
News: Important change impacts all CDI programs that review mortality charts
CDI specialists that incorporate quality measures review in their duties take note: The Joint Commission on Dec. 16 updated its Specifications Manual for National Hospital Inpatient Quality Measures. Effective for discharges July 1, 2012, patients documented as receiving "Palliative Care" and "Palliative Measures" will not be excluded from quality improvement measures.
Release Notes version 4.1 of the Specifications Manual states:
"Since palliative care is increasingly being offered as a care program provided with curative treatment, patients should not be excluded from quality improvement measures because they enter a palliative care program."
Patients who receive palliative care are currently excluded from certain quality measures. CDI specialists should query for documentation of the term "comfort care," when appropriate, to ensure that these types of patients are properly excluded.
Note that comfort care "includes attention to the psychological and spiritual needs of the patient and support for the dying patient and the patient's family. Comfort Measures Only are not equivalent to the following: Do Not Resuscitate (DNR), living will, no code, no heroic measure," according to the Specifications Manual.
Visit the Joint Commission web site to download the latest Specifications Manual.
Editor's Note: This information was provided courtesy of Cheryl Ericson, MS, RN, manager of Clinical Documentation Integrity and core measures abstraction for the Medical University of South Carolina and a member of the ACDIS Advisory Board.
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I hope this helps.
Lisa
Lisa Romanello, RN,BSN,FNS,CCDS
CDI Specialist
CJW Medical Center
Chippenham Campus
804-228-6527
Christine Reed, RN, BSN
Best Regards,
Cari Merlina RN, BSN
Clinical Documentation Improvement Specialist
Revenue Cycle
Yampa Valley Medical Center
p.970.871.2425
f.970.875.2796
Cari.merlina@yvmc.org
[yvmc]
Katy Good, RN, BSN, CCDS, CCS
Clinical Documentation Program Coordinator
Flagstaff Medical Center
Kathryn.Good@nahealth.com
Cell: 928.814.9404
I think it's a great initiative to include clear and compassionate communications by clinicians.
I have proposed nursing do a PIP on this.
Best Regards,
Cari Merlina RN, BSN
Clinical Documentation Improvement Specialist
Revenue Cycle
Yampa Valley Medical Center
p.970.871.2425
f.970.875.2796
Cari.merlina@yvmc.org
Best Regards,
Cari Merlina RN, BSN
Clinical Documentation Improvement Specialist
Revenue Cycle
Yampa Valley Medical Center
p.970.871.2425
f.970.875.2796
Cari.merlina@yvmc.org
Encounter for palliative care
Coding Clinic, Fourth Quarter 1996 Page: 47 to 48 Effective with discharges: October 1, 1996
Related Information
PALLIATIVE CARE
Code V66.7, Encounter for palliative care, has been created effective October 1, 1996 to classify encounters for end-of-life care, hospice care and terminal care. Code V66.7 may not be used as the principal diagnosis. Sequence first the underlying disease, such as carcinoma, AIDS, etc. Code V66.7 may be assigned as an additional code to identify patients who receive palliative care in any health care setting, including a hospital.
Palliative care is an alternative to aggressive treatment for patients who are in the terminal phase of their illness. Palliative care is focused towards management of pain and symptoms, and is often more appropriate than aggressive hospital treatment for patients dying of incurable diseases. The care provided is dependent on the terminal illness. Currently, between 20-30% of health care expenditures in the United States are devoted to treating persons in their last year of life. More than half of the costs of care during the last year of life are spent in the last 90 days of life.
Question:
A patient is admitted with end-stage lung cancer for palliative care only. How should this be coded?
Answer:
Assign code 162.9, Malignant neoplasm of bronchus and lung, unspecified, and code V66.7, Encounter for palliative care.
Clarification - palliative care
Coding Clinic, First Quarter 1998 Page: 11 to 12 Effective with discharges: January 15, 1998
Related Information
Clarification, Palliative Care
A new code for palliative care, V66.7, became effective October 1, 1996. A brief explanation of how it should be used was published in Coding Clinic, Fourth Quarter 1996. A further explanation is now being provided to clarify the proper use of the code.
Code V66.7 can be used for any terminally ill patient receiving palliative care. It is always a secondary code. The terminal condition should be the principal diagnosis. It may be used when a patient is brought in for aggressive treatment for a terminal condition and during the encounter it is determined that further aggressive treatment is no longer appropriate and palliative care is initiated.
The physician documentation in the medical record must substantiate that palliative care is being given. 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. The physician should be queried if the treatment record seems to indicate that palliative care is being given but the documentation is unclear. The care provided must be aimed only at relieving pain and discomfort for the palliative care code to be applicable.
Palliative care
Coding Clinic, Third Quarter 2008 Page: 13 to 14 Effective with discharges: September 19, 2008
Related Information
Question:
An elderly patient with metastatic lung carcinoma is admitted with fever and chills and is diagnosed with pneumonia and urinary tract infection. The principal diagnosis is pneumonia. During the hospitalization, the patient develops severe sepsis and respiratory failure requiring a ventilator. On the day before the patient expires, she is extubated and taken off of Levophed. On the day she expired, the physician documented, "extubated yesterday with goals of comfort/ palliative care." In addition, the physician's plan states, "Continue palliative approach to respiratory failure--increase Morphine to limit work of breathing, stop intensive monitoring, consult palliative care service, continue scopolamine." The patient expired an hour after this note was written. Is it appropriate to assign code V66.7, Encounter for palliative care, as a secondary diagnosis in this situation?
Answer:
Yes, it would be appropriate to assign code V66.7, Encounter for palliative care, as a secondary diagnosis in this case. 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. As stated in Coding Clinic, First Quarter 1998, pages 11-12, "Code V66.7 can be used for any terminally ill patient receiving palliative care. It is always a secondary code. The terminal condition should be the principal diagnosis. It may be used when a patient is brought in for aggressive treatment for a terminal condition and during the encounter it is determined that further aggressive treatment is no longer appropriate and palliative care is initiated."
Comfort care
Coding Clinic, Third Quarter 2010 Pages: 18-19 Effective with discharges: October 1, 2010
Related Information
Question:
The patient, an 88-year-old male, was admitted to the intensive care unit (ICU) following a massive intracerebral hemorrhage. Because of patient age, the size of the hemorrhage, and poor prognosis, a conference was held with the family and they agreed to discontinue life support and declined placement of a feeding tube. The provider documented comfort care and pain control. What clinical protocol is required in order to assign code V66.7, Encounter for palliative care? Is it appropriate to assign code V66.7 as a secondary diagnosis?
Answer:
Yes, assign code V66.7, Encounter for palliative care, as an additional diagnosis. Code V66.7 is for use to describe comfort care, palliative care and/or end of life care for terminally ill patients. If, however, the documentation is not clear regarding palliative care versus nonpalliative, query the provider for clarification. It is beyond the scope of the Editorial Advisory Board for Coding Clinic to provide clinical protocol for palliative care.
Katy Good, RN, BSN, CCDS, CCS
Clinical Documentation Program Coordinator
Flagstaff Medical Center
Kathryn.Good@nahealth.com
Cell: 928.814.9404
cari
I love our palliative care team! They are invaluable and I recommend them for everyone facing a terminal/life altering dx even when death is not eminent. But it seems to me that the code is meant to capture 'comfort care' not everyone receiving palliative care (including those also receiving aggressive care). Seems like a bit of a disconnect between the clinical and coding language...
Katy Good, RN, BSN, CCDS, CCS
Clinical Documentation Program Coordinator
Flagstaff Medical Center
Kathryn.Good@nahealth.com
Cell: 928.814.9404
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Paul Evans, RHIA, CCS, CCS-P, CCDS
Manager, Regional Clinical Documentation
Sutter West Bay
633 Folsom St., 7th Floor, Office 7-044
San Francisco, CA 94107
Cell: 415.412.9421
evanspx@sutterhealth.org
Palliative care is an interdisciplinary medical specialty that focuses on preventing and relieving suffering as well as supporting the best possible quality of life for patients and their families facing serious illness. While all care that is delivered by hospice can be considered palliative care, not all palliative care delivered is in hospice. Palliative care can be appropriately offered to patients at any time along the trajectory of any type of serious life-threatening illness, even concurrent with restorative, life-prolonging therapies.
Clearly the 'encounter for Palliative care' code is meant to capture comfort or hospice care which is a portion of the patients that receive palliative care.
Katy Good, RN, BSN, CCDS, CCS
Clinical Documentation Program Coordinator
Flagstaff Medical Center
Kathryn.Good@nahealth.com
Cell: 928.814.9404
Best Regards,
Cari Merlina RN, BSN
Clinical Documentation Improvement Specialist
Revenue Cycle
Yampa Valley Medical Center
p.970.871.2425
f.970.875.2796
Cari.merlina@yvmc.org