Health Information Management

Q&A: Coding for palliative care

HIM-HIPAA Insider, August 23, 2011

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Q: I am auditing records that include diagnosis code V66.7 (palliative care) for patients who subsequently expired. Must a physician write an order to initiate comfort care, or is documentation of the order for a palliative consult sufficient to report V66.7, assuming the diagnosis is mentioned in the discharge summary and progress note? 

The facility does not require an order for palliative care—it only requires documentation of that care in the record. I cannot find any specific reference to the requirement for an order; however, I worry that our practice of coding palliative care without an explicit order is noncompliant. What are your thoughts?
 
A: Coding Clinic, Fourth Quarter 1996, originally addressed code V66.7. Coding Clinic, First Quarter 1998, Vol. 15, No. 1, p. 11, provides additional clarification. The latter states that code V66.7 may be used for any terminally ill patient receiving palliative care. Coders should always report it as a secondary code.
 
The principal diagnosis should always be the terminal condition. Coding Clinic further states that coders may report the code when a patient receives aggressive treatment for a terminal condition and, during the encounter, the provider determines that further aggressive treatment is no longer appropriate and initiates palliative care.
 
Physician documentation must substantiate that palliative care is being provided. Coding Clinic, First Quarter 1998, Vol. 15, No. 1, states:
Terms such as comfort care, end-of-life care, and hospice care are all synonymous with palliative care. These, or similar terms, need to be written in the record to support the use of code V66.7. The physician should be queried if the treatment record seems to indicate that palliative care is being given but the documentation is unclear. The care provided must be aimed only at relieving pain and discomfort for the palliative care code to be applicable.
 
Palliative care, comfort care, end-of-life care, or hospice care must be written in the record to support the use of code V66.7. If a patient receives this type of care, but documentation is unclear, coders should query the provider.
 
Editor’s note: Sandra L. Sillman, RHIT, PAHM, a DRG coordinator at Henry Ford Hospital & Health Network answered this question in the August issue of Briefings on Coding Compliance Strategies.



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