Navigating the landscape of end-of-life care can be complex, especially when it comes to medical coding and documentation. Terms like palliative care, hospice care, and comfort care are often used interchangeably, yet they carry distinct meanings, particularly within the context of healthcare coding. Accurate coding is crucial for reflecting the care provided and ensuring appropriate healthcare data analysis. This article clarifies these terms, focusing on their implications for Coding End-of-life Care scenarios and ensuring accurate medical records.
Understanding Palliative Care Coding
Palliative care is specialized medical care designed to improve the quality of life for individuals facing serious illnesses. The National Institute on Aging (NIH), a division of the National Institutes of Health, defines palliative care as:
Palliative care is specialized medical care for people living with a serious illness, such as cancer or heart failure. Patients in palliative care may receive medical care for their symptoms, or palliative care, along with treatment intended to cure their serious illness. Palliative care is meant to enhance a person’s current care by focusing on quality of life for them and their family.
This definition underscores a key aspect of palliative care: it can be provided alongside curative treatments. Palliative care focuses on managing symptoms and improving the patient’s and their family’s overall well-being, regardless of the stage of illness.
The Centers for Medicare & Medicaid Services (CMS) further elaborates on palliative care, stating:
Palliative Care: Focuses on relief from physical suffering. The patient may be being treated for a disease or may be living with a chronic disease and may or may not be terminally ill.
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Addresses the patient’s physical, mental, social, and spiritual well-being, is appropriate for patients in all disease stages, and accompanies the patient from diagnosis to cure. Uses life-prolonging medications.
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Uses a multi-disciplinary approach using highly trained professionals. Is usually offered where the patient first sought treatment.
CMS highlights that palliative care is a holistic approach, addressing various dimensions of a patient’s well-being and is applicable across all stages of illness, from diagnosis onward. Importantly, it can include life-prolonging treatments, differentiating it from hospice care.
Differentiating Hospice Care in Coding
Hospice care, while also focused on comfort and quality of life, is specifically designed for patients nearing the end of life. CMS defines hospice care in contrast to palliative care:
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Available to terminally ill Medicaid participants. Each State decides the length of the life expectancy a patient must have to receive hospice care under Medicaid.
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In some States it is up to 6 months; in other States, up to 12 months. Check with the State Medicaid agency if there are questions.
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Makes the patient comfortable and prepares the patient and the patient’s family for the patient’s end of life when it is determined treatment for the illness will no longer be pursued.
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Does not use life-prolonging medications.
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Relies on a family caregiver and a visiting hospice nurse. Is offered at a place the patient prefers such as in their home; in a nursing home; or, occasionally, in a hospital.
Hospice care is characterized by its focus on terminally ill patients, with a limited life expectancy, and the cessation of curative treatments. The goal shifts entirely to comfort and preparing for the end of life, without the use of life-prolonging medications. Hospice care settings are also more patient-centered, often taking place in the patient’s preferred environment.
Understanding Comfort Care in the Context of End-of-Life Coding
Comfort care is often considered a component within both palliative and hospice care, particularly at the end of life. NIH defines comfort care as:
Comfort Care is an essential part of medical care at the end of life. It is care that helps or soothes a person who is dying. The goals are to prevent or relieve suffering as much as possible and to improve quality of life while respecting the dying person’s wishes.
Comfort care emphasizes symptom management and maximizing quality of life when a cure is not the primary goal. It is about providing relief and support during the dying process, aligning with the patient’s desires and needs.
ICD-10-CM Coding for End-of-Life Care: Palliative Care, DNR, and Facility Placement
In the ICD-10-CM coding system, understanding these distinctions is vital for accurate medical coding, especially for end-of-life care scenarios. While “Comfort Care” and “Hospice” are not directly indexed in ICD-10-CM, “Palliative care” is, directing coders to Z51.5 Encounter for Palliative Care.
The ICD-10-CM tabular instructs to “Code also condition requiring care” at the Z51 category level, but provides no further specific guidance at the Z51.5 code level. However, the American Hospital Association (AHA) Coding Clinic Q3 2010 clarifies that both “Comfort Care” and “End of life care” should be coded as Encounter for Palliative Care (Z51.5). This suggests a broader application of Z51.5 to encompass various forms of end-of-life comfort-focused care.
It’s crucial to note that for accurate coding of Z51.5, the documentation should clearly indicate that palliative care services were actually initiated during the encounter. Simply documenting an order for palliative care is insufficient if the services were not provided during that specific encounter.
Another essential code in end-of-life care coding is Z66 Do Not Resuscitate, often referred to as DNR. ICD-10-CM indexes “Do Not Resuscitate” under “DNR” leading to code Z66, with the tabular including “DNR status.” Capturing the Z66 code is important as it can impact quality scoring algorithms and mortality metrics. In mortality reviews, cases with a Z66 code are sometimes excluded, highlighting the significance of DNR status in interpreting healthcare outcomes.
Beyond specific care types and DNR status, Z75.1 Person awaiting admission to adequate facility elsewhere is another valuable code in the context of end-of-life care coding. Extended hospital stays due to difficulties in post-acute care placement are increasingly common. Code Z75.1 can reflect this situation, providing valuable data for analysis, particularly in mortality methodologies and length of stay assessments. While official coding guidelines for Z75.1 are lacking, its use can provide crucial insights into discharge planning challenges and their impact on hospital metrics.
Conclusion: Ensuring Accuracy in Coding End-of-Life Care
Accurate coding of end-of-life care, including palliative, hospice, and comfort care, is paramount for reflecting the true nature of patient care and for generating reliable healthcare data. Understanding the nuances between these terms and their corresponding ICD-10-CM codes—Z51.5 for palliative and comfort care encounters, Z66 for DNR status, and Z75.1 for delayed discharge due to placement issues—is essential for healthcare professionals involved in coding and clinical documentation integrity. By focusing on precise documentation and coding practices, healthcare facilities can ensure data accuracy, improve quality reporting, and ultimately enhance patient care.
References:
Hospice vs. Palliative Care: What’s the Difference? | VITAS Healthcare; https://www.nia.nih.gov/health/what-are-palliative-care-and-hospice-care;
Palliative Care vs. Hospice Care Similar but Different (cms.gov)
