Using Z51.5 Encounter for Palliative Care as Principal Dx
Our Coding and CDI are discussing the use of Z51.5 Encounter for Palliative Care as the principal diagnosis with our Billing team because we have physicians admitting patients when the encounter clearly (and sometimes not so clearly) is for comfort care/palliative care. Our pre-bill grouper is denying these cases with Z51.5 as the principal diagnosis. Can anyone share guidance of what you are doing and what is correct? A couple examples:
1) Patient enters ED with hemorrhagic stroke. Family decides no interventions. Physician writes admit order for Palliative Care/Comfort Care.
2) Oncology admits patient from home who has chosen home hospice but family then decides they are uncomfortable with managing the patient at home and wants patient admitted for comfort care till death, which is imminent.
Below is the Coding Clinic:
1st Q ICD 10 2017 pages 48-49 Can code Z51.5, be listed as pdx when the reason for the encounter is to receive palliative care? Yes, assign code Z51.5 as pdx when palliative care is documented as the reason for the patient's admission. Z51.5 encounter for palliative care, is used to classify admissions or encounters for comfort care, endo of life care, hospice care and terminal care for terminally ill patients. It may be used in any health care setting. Code Z51.5 can be used in multiple care settings where it may be the first-listed diagnosis, but it typically not the pdx in the inpatient hospital setting. In many cases, it would be more appropriate as a secondary diagnosis, because it is not normally the reason for a hospital inpatient admission.
Comments
Example 1- I would take the hemorrhagic stroke if it was new to the encounter- even though the final decision was comfort care- the stroke brought the patient to the hospital, was worked up and diagnosed and the deficits were managed.
Example 2- is clearly a palliative care admission.
Concur w/ Laurie's logic regarding example 1 versus 2. I would think the Z51.5 would more often be applied for admission to a GIP (inpatient) episode of care rather than an acute medical/surgical.
Hint: if/when your site makes a patient comfort care, IF your site than transfers the patient to a GIP site with a separate designation or license, this is a discharge from Acute and admission to GIP. It may be important to ensure proper orders and workflow instituted or the expired case will attributed to mortality on the first, inpatient encounter, which may not be the intent. This can impact your O/E.
Paul
CCDS
I am going to chime in with I also agree, example 1- Pdx would be hemorrhagic stroke and example 2- would be for palliative care