Using Z51.5 Encounter for Palliative Care as Principal Diagnosis

Patient with lung cancer currently undergoing radiation, unable to get chemo due to advanced disease, was brought to the ER via EMS with SOB.  Patient was diagnosed with acute respiratory failure, CHF and AF with RVR.  Patient received treatment for these conditions in the ER and was going to be transferred to tertiary care facility but no ICU beds were available.  After discussion with family, they wanted to keep the patient here and be more comfortable than aggressive.  Admission orders: Admit to inpatient, ICU, comfort care, scopolamine patch, morphine and Ativan PRN. 

I'd appreciate thoughts on whether Z51.5 or acute respiratory failure is the correct principal diagnosis in this case? 


  • I would assign Z51.5 as the principal diagnosis.  This was the main reason for the admission.  
  • Inpatient encounter includes all diagnoses present in the ED. Unscheduled encounter to ED with acute conditions, to include, ARF and CHF.  One of the qualifying acute conditions is the PDX.  

    From the description, presents in extremis with life-threading acute conditions requiring unplanned is stabilized.  After discussion and consideration with patient and family, the patient is placed on Comfort Care.  The PDX is the acute respiratory failure in this situation per definition of the PDX.
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