Re: Documentation of palliative care vs comfort care
Here is a reference I have been given, I hope you find it useful:
This is a composite of advice from Coding Clinic, CMS and Hospice
programs. Note that there is no requirement to meet all bullet points.
This level of care can be elected any time during the admission—even on
the last day of service. The patient, or their representative, may change
their mind any number of times during the stay and V66.7 can still be
assigned as long as the patient was receiving palliative care for any
amount of time during the admission.
Minimum criteria for assignment of V66.7:
· Physician documentation of “comfort care”, “end-of-life care”, or
“hospice care”. (These are all synonymous with palliative care.) This can
be in the form of a physician order or documented in a progress note.
· Physician documentation of either a terminal illness, or multiple
co-morbidities w/ no primary diagnosis
Rationale:
Any of the following documentation helps to justify the provision and
reporting of palliative care. Note that not all elements are required, or
even appropriate, for all patients.
Orders for palliative/hospice that may include:
Ø Pain management
Ø Management of acute symptoms, e.g. intractable nausea, vomiting,
seizures
Ø Respite care, if appropriate
Ø Consult for Palliative Care
Ø Consult of Social Services, dieticians, rehab therapists, and
clergy
Ø DNR status & order if elected by patient
Documentation of Need for Palliative Care:
· Terminal illness; or
• Multiple co-morbidities w/ no primary diagnosis
• Greater than 10% weight loss over 6 months
• General physical decline
• Serum albumin< 2.5 g/dl
• Reduced performance status (e.g. Karnovsky score
This is a composite of advice from Coding Clinic, CMS and Hospice
programs. Note that there is no requirement to meet all bullet points.
This level of care can be elected any time during the admission—even on
the last day of service. The patient, or their representative, may change
their mind any number of times during the stay and V66.7 can still be
assigned as long as the patient was receiving palliative care for any
amount of time during the admission.
Minimum criteria for assignment of V66.7:
· Physician documentation of “comfort care”, “end-of-life care”, or
“hospice care”. (These are all synonymous with palliative care.) This can
be in the form of a physician order or documented in a progress note.
· Physician documentation of either a terminal illness, or multiple
co-morbidities w/ no primary diagnosis
Rationale:
Any of the following documentation helps to justify the provision and
reporting of palliative care. Note that not all elements are required, or
even appropriate, for all patients.
Orders for palliative/hospice that may include:
Ø Pain management
Ø Management of acute symptoms, e.g. intractable nausea, vomiting,
seizures
Ø Respite care, if appropriate
Ø Consult for Palliative Care
Ø Consult of Social Services, dieticians, rehab therapists, and
clergy
Ø DNR status & order if elected by patient
Documentation of Need for Palliative Care:
· Terminal illness; or
• Multiple co-morbidities w/ no primary diagnosis
• Greater than 10% weight loss over 6 months
• General physical decline
• Serum albumin< 2.5 g/dl
• Reduced performance status (e.g. Karnovsky score
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