|Pre-ICD10 counterpart:||Palliative Service|
|APACHE Como Component:||none|
|APACHE Acute Component:||none|
|External ICD10 Documentation|
- 1 Additional Info
- 2 Regarding Coding Prior to Admission versus Related to Admission versus After Admission
- 3 Alternate ICD10s to consider coding instead or in addition
- 4 Candidate Combined ICD10 codes
- 5 Related CCI Codes
- 6 Data Integrity Checks (SMW)
- 7 Legacy info
- 8 Related Articles
- This diagnosis code captures 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 diagnostic 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 Comorbid Diagnosis, Admit Diagnosis or Acquired Diagnosis.
- 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 Dx Type.
- If the person doesn't meet one or more of the criteria until the day after admission, or thereafter -- then code it as an Acquired Diagnosis
- 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 Dx Type 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 Dx Type is Related to Admission -- even if it took some hours after admission to get the symptom control going.
This code vs Comfort Care
We are currently reviewing whether Comfort Care will still be needed. For now, keep coding it as an entry unrelated to this one. The discussion about continuation is on that page, and it has a reminder to clean up here when complete.
Alternate ICD10s to consider coding instead or in addition
Candidate Combined ICD10 codes
Related CCI Codes
Data Integrity Checks (SMW)
We used to code some similar concept under Palliative Service. That code had criteria based on involvement of the palliative service. The new ICD10 code can be used whether or not the service is involved.