End of Life Secondary Diagnoses
We are actively discussing what diagnoses are "appropriate" to code when you have a patient who has been made comfort care after a lengthy hospitalization and made GIP status or who comes in with an acute event and due to the nature of the event, the patient is made comfort care rather quickly. Example #1: middle age man with end stage lymphoma and known PNA during inpatient stay changed to GIP status and placed on morphine and Ativan drips. Pt is essentially non responsive the day of the transition to GIP status and lives for several days. The patient is totally dependent on nursing care. What are everyone's thoughts about the diagnosis of coma (pt is unresponsive but is on high doses of narcotics for pain), functional quadriplegia (pt is totally dependent and requiring incontinence care, turning, etc but was a one assist on the inpatient stay), pt was experience cheyne stokes respirations which codes to periodic breathing, and what about the known PNA-it was not being treated with the change to GIP but was definitely considered in the medical management of placing the patient on hospice. Our coders argue that the coma and functional quadriplegia is part of the dying process made worse by the narcotics and feel cheyne stokes respirations are also part of the dying process and therefore shouldn't be coded. Hospice guidelines state to code all related diagnoses. I hope to meet with our palliative care director soon to discuss further. Is anyone else having these types of discussions currently?
Comments
Intent of data reporting/coding to report diseases, and the conditions you referenced are known consequences of interventions/medication. Should not be coded. Natural processes of death, such as 'cardiac arrest' & cheyne stokes not reportable as natural expiration process. Generally, we code those conditions part of the presentation and medical-decision making leading to decision place pt on Comfort Care, but do not code drug-induced conditions that are intended/induced by intervention. See previous similar discussion on this thread for more perspectives.
Paul Evans, RHIA, CCDS
when we are giving heavy narcotics, I think its pretty tough to support coding of dx like resp failure, cheyne stokes, and functional quadriplegia. As for the PNA, I would code this.
Katy
We've had several cases lately where the patient came in with tons of acute issues and the family made comfort care ASAP...just nothing much to code. We are supposed to be getting inpatient hospice soon so I will be picking everyone's brains that have this service at their facilities.
Jeff
Paul, where would I find coding references regarding the above? Thanks,
Valerie