Wiki Palliative Care Coding-Symptoms or conditions?

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Hi Everyone,

I need input on a specific topic regarding Palliative care coding. I've read many articles online and read through forums to try to obtain these answers and I feel that they are all over the place. When coding for Palliative care, I was told that symptoms are coded over definitive conditions, and I've also been told to code definitive conditions as well if they are appropriate. I find it hard to distinguish when to do this. Does anyone have a straight answer for me, I want to relay the message to my Palliative providers correctly. For example: provider is documenting that the patient has dyspnea due to COPD exacerbation. Do I code the dyspnea or the COPD exacerbation? I want to code the COPD because it is confirmed, however the provider is concerned with the COPD being used for the same day by another provider. Any input on this topic would be very helpful!

Thank you in advance.
 
My providers personally bill the symptoms first because that is what we are being consulted for. For instance we will bill G89.3 and then what ever cancer the pt has that is causing the pain. Or we would use dyspnea first followed by COPD. We also use z51.5 as primary dx so there is no kick back from insurances and using the same dx on the same day. We used to not be able to use z51.5 as primary, but since CMS did a policy update on October 2017 going in effect for the year 2018 you are now allowed to use z51.5 as primary.

https://www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/AcuteInpatientPPS/FY2018-IPPS-Final-Rule-Home-Page-Items/FY2018-IPPS-Final-Rule-Data-Files.html?DLPage=1&DLEntries=10&DLSort=0&DLSortDir=ascending
Go down to the downloads section and clicked on
Definition of Medicare Code Edits v35 (10th one down)
When looking at the index it tells you to go to
Unacceptable principal diagnosis ................................................................................ 301
When scrolling down on page 323 it states
The following codes were removed
The last code is z515
 
The primary diagnosis is always Z51.1. We code the symptomology causing the patient's distress (usually pain, SOB, weight loss etc.) Palliative care is not curative treatment, so we never code out the disease (and you never code the disease and symptoms on the same account, anyway).
 
We report Z51.5 primary then the symptoms/problems for which the patient was referred to Palliative Care (physician-based billing).
 
Can Palliative care be the primary diagnosis in the provider office setting? Ninety-Five year old patient was recently discharged from the hospital where she was treated for anemia. Provider is seeing the patient for follow-up and coded the Z51.5 code as primary. Discussion of end of life concerns were addressed with the patient and family. Provider addressed the anemia, dark stools and tachycardia in the A&P.
Is Z51.5 appropriate in this situation?
 
I would not report Z51.5 on the claim if your provider is not a palliative care physician. "End of life discussion" does not equal "palliative care". I only ever reported Z51.5 for those patients referred to our palliative care clinic or seen in follow-up in the pc clinic who were seen by one of our two medical oncologists with a subspecialty in palliative care.

Someone else may have a different experience.
 
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