Palliative Care

MariaB

Have any of you ever been instructed on the use of the Palliative Care code?

In the past, the coders in my agency were advised that there is no real skill in palliative care, and will not support skilled visits. I know to not use the code primary, but more than that, we were instructed to never use it at all. (Judy Adams, contributing author of the DH coding book, advised us of this when she was a consultant for our agency.) But within the past few months, more and more, it seems the clinicians/clinical managers are requesting the code be added to the claim as "it will support prolonged amount of visits by SN." ...which is the direct opposite of what we were initially taught.

So, I am wondering if anything has changed? I'm going to reach out to our consultant again, but I wanted to know if and how you are using the code in your agency.

Thanks,

J. Maria Brandt
CPC, HCS-D, CIC, CCS, CRC
Medical Coding Specalist
Riverside Home Care
856 J. Clyde Morris Boulevard, Suite C
Newport News, VA 23601

tstrauss@elevatehomehealth.com

For our company and accuracy of coding for home health palliative care code is never used.

Hope that helps


Traci Strauss RN, COS-C, HCS-D
Clinical Reimbursement Specialist
209-914-3521

SusanWinokur

Z51.5 would not be in the coding manual for no reason. It is specifically intended to be used as a secondary code for hospice and palliative care cases. If you are coding a non-hospice, non-palliative care patient, I would only use this code if the physician documents that the care ordered is for palliation. Codes alone do not explain the severity of a diagnosis, that comes from the clinical documentation.

Susan Winokur, HCS-D, BCHH-C | Southwest Medical
Part of OptumCare
Senior Medical Coder, Home Health

8655 South Eastern Avenue, Las Vegas, NV 89123 USA
T    +1 702-838-0644
Susan.Winokur@optum.com
smalv.com

MariaB

Thank you both. Just an FYI, this is the feed-back our consultant provided me...

Z 51.5 Encounter for palliative care is an appropriate code for hospice care or palliative care as a secondary diagnosis that notified the reviewer that skilled nursing is addressing symptom management for symptoms that are integral to a diagnosis or code or the symptoms that need to be managed that do not have a definitive cause. It is not a code I would use to support a lot of skilled nursing visits in home health unless the physician ordered palliative care and then the medical record documentation will need to support what skilled care is needed (why are the skills of a nurse required and what are they managing). - Cannot just be ongoing monitoring of a stable condition. For coverage, you would need a diagnosis (diagnoses) that describes the patient's needs - such as the underlying clinical condition that requires palliative care and good documentation to support the need for the skilled level of nursing.

Need to be careful using this code in home health where the focus of care is on active interventions and curative care. Hospice, on the other hand, is supportive care and managing the evolving symptoms that arise as a patient is nearing the end of life. There is nothing that says Z51.5 cannot be used in home health, but it is seldom used and can be a red flag for audits about the medical necessity of care. Generally in home health situations, there are more specific codes that would better support the skilled need for care than palliative care.