Palliative Service

Legacy Content

This page is about the pre-ICD10 diagnosis coding schema. See the ICD10 Diagnosis List, or the following for similar diagnoses in ICD10:Palliative care

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Category/Organ System:	Category: Palliative Care -'''''update pending''''' (old)
Type:
Main Diagnosis:	904-00
Sub Diagnosis:	Critical Care and/or Medicine
Diagnosis Code:	Currently Collected
Comorbid Diagnosis:
Charlson Comorbid coding (pre ICD10):
Program:
Status:

Palliative care is care including pain and symptom management, social, psychological, cultural, emotional and spiritual support as well as caregiver and bereavement support that is given to a person with progressive, advanced, or chronic disease with little or no prospect of cure whose death is apparent however is not immediately imminent. (Health Canada website) Palliative care might be provided even if disease treatment has been discontinued in an ICU patient.

Current obstacles to consistent coding practices for Pallitive Care

Current collection problems with Palliative care code:TOstryzniuk 16:06, 25 June 2008 (CDT)

●Some collectors code palliative care when status is coded as ACP1.(VIC).Others are saying that ACP (Advanced Care Plan) information at their site is not in the chart, others coding palliative when they see ACP 1 or 2 is documented in the chart, others are coding palliative care only when physician writes to word palliative care in notes/orders or fills out a form for palliative care consult. The debate is that it is not a Dr’s decision but the patient and families..........

●Hospitals in the city, not all sites seem to document Advance Care Plan (ACP)status on admission? Is this correct? (thought this was a regional requirement for every admission?)

●Collectors suggest it would be better collect the ACP status instead, though I am told this could change with every new admission to hospital ?

●collectors want to know the purpose of collecting that status of “palliative care” and how this information is being used.

●Issue of same patient with multiple admissions back to hospital once being deemed "palliative care". Subsequent admission not alway documenting that patient has been deemed palliative care previously. Example pt with end stage heart disease, palliative care 2003, frequent admission (14 repeated admits) for CHF, CP and other reversible problems, but no mention of palliative care in Dx codes until 2007.

●What is a reasonable time line for "immediately imminent" vs. not immediately imminent? (example; patients DC TX in ICU, did not die immediately, not until 1-2 weeks after ward admission. Should ward call this DC TX or palliative or both?

When to code Palliative Care (update pendingTOstryzniuk 15:59, 25 June 2008 (CDT))

The diagnosis Palliative care should be coded for patients where all of the following are true:

• Patient either on Medicine ward or in ICU
• active care of reversible conditions is given to a person with progressive, advanced underlying disease with little or no prospect of cure. Underlying disease condition is terminal.
• death is apparent however is not immediately imminent

NOTE: Trish is looking at this definition. I will add more detail and will review with Roberts. Need to inlclude a purpose as to why we are tagging these patients. TOstryzniuk 17:27, 24 June 2008 (CDT)TOstryzniuk 19:16, 21 July 2008 (CDT)still working on it. Contributions welcome.

When not to code Palliative Care (update pendingTOstryzniuk 17:49, 25 June 2008 (CDT)

For our purposes and the way we analyze the data, a patient whose death is immediately imminent should not be coded as Palliative care, but might be coded as DC Treatment if appropriate.

Further info required to un-stub

• Incorporated Laura's definition from Health Canada. However, will we code if only some of the aspects of palliative care (e.g. pain mgmt, but not emotional support) are provided? In the end, this is a coding guide, and the above makes is less clear when to code. The "when to code..." section should be updated to clarify which parts of definition are mandatory, or how to gather from chart. I suppose the main information is that the focus of care is for comfort rather than active treatment. LKolesar
  • the focus of care is the active treatment of "reversible" conditions for those patients whose underlying disease condition cannot be cured.
  • Ok we need to continue work on this definition further. It is a given that emotional, spiritual, treatment of pain etc is part of any type of patient care...........TOstryzniuk 19:09, 21 July 2008 (CDT)

Discussion

• I have a ? about pall care vs dc treatment

Pts are transfered to D5 from the icus to die I put in my 1st admit pall care and I add d/c treatment, does icu put pall care in acquired as well as d/c treatment or do I put in my 1st admit the cause of their demise with d/c treatment. How do you wish these cases to be coded. (Pat Stein) We’ re only after part of the data within the ACP documents as they affect whether or not a patient would be a candidate for a higher level of care which would be ICU.

• • From Dan Roberts- further discussions: (July 2008)
• All this relates only to determinations made at the time of admission.We need to know 2 things.
• If a patient is terminal and it is decided not to continue active treatment, that is palliative.
• The next issue we need to capture is whether or not a patient has a DNAR order at the time of admission.What is in the ACP IS NOT RELAVENT.
• Therefore we need to capture palliative vs non palliative .If non palliative is there a DNAR? (For palliative patients there must always be a DNAR.).
• This information helps us to determine who can be excluded from randomization to a higher level of care at the time of admission.The palliative patients would never go to high obs and the non palliative patients with DNARs would require further screening to determine their candidacy for ICU.However that subsequent screening information would not be required for the database.
• Status on a previous admission is relevant for the care team determining level of care for the present admission but only the determination for this admission is relevant.
  • FINAL DEFINTION PENDINGTOstryzniuk 14:58, 4 July 2008 (CDT)

Further to unstub

• Incorporated Laura's definition from Health Canada. However, will we code if only some of the aspects of palliative care (e.g. pain mgmt, but not emotional support) are provided? In the end, this is a coding guide, and the above makes is less clear when to code. The "when to code..." section should be updated to clarify which parts of definition are mandatory, or how to gather from chart. I suppose the main information is that the focus of care is for comfort rather than active treatment. LKolesar

Trish Here....

• • the focus of care is the active treatment of "reversible" conditions for those patients whose underlying disease condition cannot be cured.
  • Ok we need to continue work on this definition further. It is a given that emotional, spiritual, treatment of pain etc is part of any type of patient care...........TOstryzniuk 19:09, 21 July 2008 (CDT)

• • My version of defintion is: Palliative care is when a pt is dying of an underlying terminal disease/condition and palliative care/comfort care is documented in chart either by palliative care form/doctor, pt may come in and out of hospital for treatment of symtoms of underlying disease/secondary issues. ACP2 and up is truly not relevant to whether or not a pt is palliative care.--PStein 08:57, 28 July 2008 (CDT)