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?