Palliative care

ICD10 Diagnosis
Dx:	Palliative care
ICD10 code:	Z51.5
Pre-ICD10 counterpart:	Palliative Service
Charlson/ALERT Scale:	none
APACHE Como Component:	none
APACHE Acute Component:	none
Start Date:
Stop Date:
External ICD10 Documentation	ICD-10 CM Wikipedia ICD-10 Wikipedia WHO ICD10 documentation ICD10data.com

This diagnosis is a part of ICD10 collection.

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  • 2019-01-01
  • 2999-12-31
  • Z51.5

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So we are now going to enter palliative Care if the criteria is met as specified below and NOT if the Palliative Service Team was Consulted ?Do we still enter comfort care in the tmp box . (skiesman) AG - yes the use of this DIAGNOSIS is as stated here, not consultation from palliative care service. The comfort care temp item stays unchanged as far as I know --- Tina/Trish? I think this was about the transition from the old "diagnosis" [Palliative Service]] to this one; the definition is different in the new one. Will this address our collection needs?

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Additional Info

• This is a diagnosis code, and is different from the Palliative Care Service -- that refers to a group of physicians. This diagnosis code refers to whether the clinical plan for the patient is to predominantly provide comfort towards the end of life, not to prolong life.
• To figure out if a person should have this diagnosis of Palliative care, you must figure out the INTENT of care. If the intent is aimed at cure and prolonging life, then the person should not be assigned this diagnostic code. If the intent IS primarily control of symptoms (whether the person currently has symptoms or not), and not cure or even prolongation of life, then the person should be assigned this code.
• We will operationalize this diagnositc code as applying if ANY of the following 4 items are true:
  • 1. ACP-C status
  • 2. Had been on palliative care prior to this hospital admission (i.e. at home or in the care facility) -- and still is
  • 3. Is receiving active palliation. What is meant by this is (again) related to the intent of care --- so receiving aggressive symptom control measures (e.g. a morphine drip) does not consitute active palliation UNLESS the intent of the overall care at this point is control of symptoms and not cure or even prolongation of life.
  • 4. The Palliative Care Service (physician group) is seeing the patient in an ongoing fashion. This means that they have seen the patient at least twice during this admission, or that they wrote that they intended to follow but the patient died or left hospital before they could be seen a second time. Thus, if that consult team saw the patient in an initial consult but didn’t or didn’t plan to follow them longitudinally, then this item doesn’t apply.
• Note that this diagnosis code is not the same as ACP-C. A patient can qualify for this diagnosis code even if they're not ACP-C. Though if they are ACP-C, they do automatically qualify for this code.

Regarding Coding Prior to Admission versus Related to Admission versus After Admission

• This code can be used in any of the 3 diagnosis bins.
• It is usually easy to figure out if the person met the criterion #2 (above), and if so this diagnosis should be in the Prior to Admission bin.
• If the person doesn't meet one or more of the criteria until the day after admission, or thereafter -- then the code would go into the After Admission bin.
• It might be difficult, however, when they meet the criteria on the day of admission. In this case it may be either Related to Admission or After Admission.
  • To decide, clarify the intent of care at admission.
  • If the initial intent ON ADMISSION was to try for cure and prolonging life, but this was changed to primarily symptom control later on the day of admission, then the appropriate bin for this diagnosis is After Admission.
  • If the initial intent ON ADMISSION was not to try for cure or prolonging life, but primarily symptom control, then the appropriate bin is Related to Admission -- even if it took some hours after admission to get the symptom control going.

Can this be used as a primary admit diagnosis for a patient who gets admitted to the ward, with clear intent of comfort care only? For example, if patient comes in with pneumonia but they are made comfort care in ER, and treatment is only aimed for symptom control, no antibiotics or oxygen. Can I use palliative care as the primary admit diagnosis or not? -allyson

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Candidate Combined ICD10 codes

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