Coding Glasgow Come Scale diagnosis in Comfort, Palliative, and/or Hospice care

kimberly.sullivan@stjoe.org

I would like to see what other facilities are doing about the coding of GCS DX codes for patients who are at end of life care (Comfort, Palliative, or Hospice).

evanspx@sutterhealth.org

Generally, consider a code for pertinent diagnoses that impact medical-decision making and mortality scores - however,  would not advocate reporting of clinical processes AFTER drugs that are a part of the palliative care are on board. (I.E..  would not code respiratory consequences of Morphine when this is administered for comfort).  We code mortality and morbidity, but not intended effect.

Not stating very eloquently, I am pressed for time.

P. Evans, RHIA, CCDS

morris-jeff@CooperHealth.edu

I would not code these after palliative care has began as these are intended effects of comfort measures as Paul stated.

Jeff

afloyd24

I agree with Jeff and Paul.  If coma is an issue prior to palliative care documentation and administration of comfort meds, I would code it but as a result of the medication or decline in condition after palliative care has been initiated, I would not. 

lostwater

as GCS scales are a broad indicator of consciousness (not just "coma"), I would be careful in submitting them, and only if appropriately documented and only prior to any consciousness altering medications are on board.

Mark

bming1120@gmail.com

Look at the instruction notes associated with the code. The direct you on what to capture, i.e. Intracranial injury with LOC. The coding pathway directs you to code the duration of loss of consciousness: 1) Not regained with death due to brain injury; 2) Not regained with death due to other cause. Both options allow you to capture the GCS scores. Although the GCS scores do not yield MCCs, the clinical picture is complete. Even if the patient converts to comfort care, it is important to capture the acuity in certain circumstances. 

When considering whether to capture or not to capture GCS scores, let the circumstances guide you. For example, if a patient admits with a CVA and loss of consciousness, never regains consciousness, and the family opts for comfort care, I would capture the GCS scores up to the time the patient was converted to comfort care.

Beth Watts, BSN, RN, CCDS
Clinical Documentation Quality Improvement Auditor
St. Joseph Health, NorCal