Wiki Palliative Care auditing

[Jessim929]

I've been asked to consult on an internal audit for palliative care charts. Is their stuff coded the same way the 99201-99233 E&M code set is? (Ailment/Data/MDM-Risk)

Any pitfalls I should be aware of? Is the code underlying symptoms and let referring provider code the actual disease rule of thumb still applicable?

Thanks in advance!

 

[TTcpc]

I've been asked to consult on an internal audit for palliative care charts. Is their stuff coded the same way the 99201-99233 E&M code set is? (Ailment/Data/MDM-Risk)

Any pitfalls I should be aware of? Is the code underlying symptoms and let referring provider code the actual disease rule of thumb still applicable?

Thanks in advance!

Yes, they follow the same E/M guidelines as other physicians.

Palliative care physicians/APPs are usually consulted to provide symptom management recommendations or to assume care of the patient for symptom management.

Under the new guidelines, I would look closely for whether the condition/symptoms are stable but not at treatment goal. Many I've seen in the past will document that the patient is currently stable; however will not mention whether they are at the treatment goal of either symptom resolution or improvement to an expected point with the methods being used.

 

[Jessim929]

That is helpful! Thank you.

 

[csperoni]

I would just add that palliative care is often one of the more time consuming specialties. You may find more visits that can be coded by time than other specialties. They OFTEN have discussions with the patient's other providers. In general, for palliative care clinicians, I would expect an E&M distribution with many higher level visits. Also, they may more frequently actually be meeting the coding definition of consults, if the carrier even still accepts them. Of course, in any specialty, documentation of all of this is key.