Principal Diagnosis for Terminal Extubation Admission

Margaret_FoleyMargaret_Foley
in Clinical & Coding

Hi all

Looking for input on principal diagnosis selection for admissions  to acute care for terminal extubations.  Are you assigning a code for the diagnosis most contributory to the terminal prognosis as the principal diagnosis?  Or, Z51.5 Encounter for Palliative Care?  Or, other? 

Below are two scenarios to provide context.

Scenario #1:  Patient is brought to the ED- Diagnosed with Acute on Chronic CHF/Respiratory failure, pt intubated, however in the ED patient's family decides they would like palliative care and would like to withdraw intubation. Pt is admitted to ICU for "terminal extubation and palliative care".

Scenario #2: Patient with stage IV lung cancer, with progressive brain metastases following radiation and multiple painful metastases admitted with severe dyspnea. Patient intubated in ED and placed on ventilator for airway protection. After further discussion with family, decision made to pursue comfort care with planned extubation after the patient’s son arrived from out of state. Patient made comfortable and admitted to 4 North Nursing Unit for planned terminal extubation. Patient expired shortly after extubation, surrounded by family, on day two of hospitalization.

Thanks

Comments

  • evanspx@sutterhealth.orgevanspx@sutterhealth.org

    Please see Official Guidelines for Coding and Reporting

    Aftercare visit codes cover situations when the initial treatment of a disease has been performed and the patient requires continued care during the healing or recovery phase, or for the long-term consequences of the disease. The aftercare Z code should not be used if treatment is directed at a current, acute disease. The diagnosis code is to be used in these cases. Exceptions to this rule are codes Z51.0, Encounter for antineoplastic radiation therapy, and codes from subcategory Z51.1, Encounter for antineoplastic chemotherapy and immunotherapy. These codes are to be first-listed, followed by the diagnosis code when a patient’s encounter is solely to receive radiation therapy, chemotherapy, or immunotherapy for the treatment of a neoplasm. If the reason for the encounter is more than one type of antineoplastic therapy, code Z51.0 and a code from subcategory Z51.1 may be assigned together, in which case one of these codes would be reported as a secondary diagnosis.
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