Wiki Palliative Care

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julieannbell

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Hi. I just started a new job (first coding job since I got CPC in December). They brought me on as a coder with no CPC to train me in Palliative Care. This is an organization that is only Palliative Care and sends Nurse Practitioners out to the patient's homes for home visits. It also looks as if this company will also want me to to do their billing, including denials. I plan to start my CPB course through AAPC. Is there anyone out there who also does Palliative Care who would be open to being there for me through this transition? So far I am seeing they look like they are under coding and the denials have not been handled appropriately. It is a big undertaking, but I feel like I can get this under control with some mentorship and guidance.
 
Hi Julieannbell👩‍🦽
Congrats on new job!! You will do fine, but ensure read areas in CPC and ICD10 manual for questions. Use this AAPC blog & journal magzaine too. Also create self cheat sheet when notice some CPT or Dx not payable or get denied.
Here are some tips I can give for billing Home Visits (new and Est. Pts) CPT 99341-99350.
If pt dies list ds disease from not death dx code. R99 means found dead body somewhere.
NP and MD must document reason for pt. visit, past history of related, medications, ROS, and pt. examinations, plan of care. Split shared visits cannot be done in this setting
If pt has ongoing DM and gets insulin use the dx Z79.4 long term insulin or oral DM meds dx Z79.84 If pt gets renew prescrib. use dx Z76.0 and reviewing current meds use dx Z51.81 and end with Z51.5 is palliative care
Use properly Z dx codes and sequence in proper order, usually last on claim. Some Z dx codes are considered first listed for claim but check ICD10 manual
If pt falls or hurt with injury list date of injury, where in home or Etc., and definitive injury dx given listing the proper characters of A,D,S
If pt has respiratory, gastro, hearing, eyes, cardiac or HTN issues and currently smokes ciggs..add the dx F17 or Z72. But Z87 is for history of smoking.Follow documentation in medical record for the day
If pt has any of the TOAD complications add it to the record once documented. (Transplants see dx Z98 block, Ostomies Amputations Z89or Dialysis Z99)
If pt is bed confined dx z74.01 blind or use wheelchair add it dx Z99.3 but code reason such as I69, G71.0 or E66 or M62.81 or J44 or cancer ds or TBI Z87.820
If pt has certain body part replacements add it too Dx Z96 block and it checked for after care check out dx block Z48 or Z47
If pt is obese use dx E66 and dx Z68 combo dx with BMI % listed in medical documentation
Also tell NP provider if pt smokes ciggs and counsel for it ensure add minutes talk about smoking cessation in med documentation and add CPT 99401-99409 and dx F17. Modifier 25 plopped on one of the CPT ranges used CPT 99341-99350.Place of serv is 12 for pt homes.
If SAR or COVID ds. in past use dx U07.1 if pt gets it again then use dx U09 for first time COVID and lab test encounter use dx . Z11.52 encounter
Advise NP document properly so coding will be accurate , at times payer may want to view it to see if can get some funds back.
I hope this data helps you.:)
Lady T
 
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Hello again Julianne Bell,;)
Few more dx tips may help you. Encourage NP to document the assessment/dx list each time and describe what is happening with the patient to obtain good coding. Hopefully equals no future insurance denials. I assume most payers, may be Medicare but ensure the payer's insurance is verified for home health coverage or primary and secondary.
Palliative care may include these common dx codes such as: G20 Parkinson Ds, Alzheimer dx G30, Stoke I60-I69 plus list paralyzed body area or any other sequela if known, Osteoarthritis (DJD) M15-M19 and dx M47.If Dementia need dx codes F02.80 Also Dementia F02 has been updated in ICD10 has stages of it and pt's behavior& code any comorbidities if listed for this pt such as R64, R54 frailty, depression F32. DM document differ levels per documentation, E11 affect eyes or CHKD or neuropathy per notations, skin issues, HTN 110 or Cardiac ongoing disease I50, I48 ,I25 and if pt. is past or current smoker or alcoholic. If pt has past HO of pacemaker or stents add dx Z95.
Remind NP to define levels or stages of disease in documentation such as; CHKD dxNI8 has 5 stages, Depression F32 has levels too, Hemorrhoids dxK64 and Pressure Ulcers L97 and types of Arthritis to name a few . They should add the chronic illness and combo dx codes.
Ensure NP document when write current history of certain ds. vs saying pt has history but adding chorological date on the past illness. This helps the coder to use Z dx history codes vs current definitive dx codes.
If pt has disease and infection/virus with it try to list both such as: dx N39 UTI need add dx B95-B97 find out lab results, same goes for respiratory disease if can find causal agents from lab test adding info in documentation aids you in detailed coding.
Well also be clear in benign neoplasm, malignant neoplasm vs cancer vs carcinoma in situ vs metastases cancer , all have differ meanings and dx codes. Use dx Z85 or Z86 if pt has PAST history of cancer which may or may not be related to current illness
Good Luck! And I hope helped you a little bit more. :)
Lady T
 
Thank you so much for all of this information. One thing I have also noticed is that Humana is rejecting most of their claims. I am going to start the CPB course soon, but for right now I am not educated on the insurances. Any idea why Humana would be rejecting every single one?
 
Hi Julieannbell,
Maybe if not pre approved OR continual use of unspecified dx codes when some disease maybe have levels or stages. The payer may want more of detailed dx codes. If the provider must do a preauthorized plan of care faxed in to payer office (check Humana rules) in which listed dx codes and treatment. However if when billed the dx codes should match but do not may cause denial. Other extra chronic conditions can be added when billed or treated for the day. Or if pt referred to home service by a provider then his or her name may need to go on the claims. Also if TCM or Chronic Complex Manage treatment done same time by other medical offices this might cause denial too. Best bet is contact Humana, read their contract, if pt. has another payer, or review all the past insurance denials. Are all the NP providers approved in their network or is credentialing done properly? Also you can look on the CMS website physician fee schedule see what CPT code matches the proper dx codes
Good Luck!
Lady T
 
I am also new to palliative care coding and want to make sure I am understanding correctly. If they come in for a consult for palliative care and it is documented the pt is unsure of how they would like to proceed, I can use time and use the icd 10 z51.5 plus the dx for the consult?
 
Is there a CPT for outpatient, in office visits for Palliative Care? Regence is telling me I need to use these along with the Z51.5. Can anyone answer this please?
 
It is the same outpatient, in office visits for any specialty, 99202-99215. What CPT are you billing with now that Regence is stating you need to also submit another CPT with?
Don't forget you should also be billing the actual medical diagnosis along with Z51.5.
 
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