# Diagnoses and Palliative Care Coding



## vjennings-2011 (May 30, 2017)

Hello,

I am working with a Palliative Care group as their Coding Educator.  They have been told by other specialists they should not code their diagnosis codes because then they cannot bill for their visit.  As a result, they are selecting symptom codes like weakness for their primary when they do a palliative consult.  As a risk adjustment trained coder I am not happy with this, however, before I start an internal conflict with my providers, I wanted to confirm the best approach to diagnosis coding for Palliative Care providers who consult in the hospital.  

Thank you in advance for any help you can provide,

VJ


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## Kris Cuddy (May 31, 2017)

First and foremost, I'd ask them to provide you with the supporting documentation for their stance on this. It should either be from a health plan or from their prior "specialists" they've consulted with on documentation and coding. Once you have that, if you do, then you can research and perhaps counter what they were advised in the past. I'm betting they were never given anything in writing so you'll have a great opportunity to bring them to the light...so to speak.


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## lrmccann (Jun 9, 2017)

I as well work with Palliative Care and they are correct they are to use their primary dx as the reason they are being consulted which is usually for sign or symptoms. Medicare will not pay for two providers to use the same primary dx code the same day so therefore if they were to use the same primary dx code then the hospitalist or whomever is the primary provider will be the only provider to get paid for their services.


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## KNelson56345 (Jun 9, 2017)

I studied up a little on this today and came up with my AHA moment (read the guidelines ). The guidelines state when the encounter is for treatment of pain due to a neoplasm that the code for the pain is sequenced first and neoplasm second. I can't find where it states that we should assign symptom codes for other diseases (like end stage Alzheimer's) that bring patients to hospice. I also found a helpful webinar that discussed the subject. http://c.ymcdn.com/sites/www.iahhc.org/resource/resmgr/211_Hospice_Coding_What_Now.pdf In this I found Z51.5 ENCOUNTER FOR PALLIATIVE CARE and this code has a note to _code also_ the reason for the palliative care. Still a newbie at this but it was interesting to look it up. If I am wrong educate me and I will be happy for the help.


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## Kris Cuddy (Jun 21, 2017)

Nice job with reading the guidelines and your research. You may be a newbie, but you're doing awesome.


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## acw (Jun 22, 2017)

I do code for palliative care in the inpatient setting.  At first we were coding signs/symptoms with Z51.5 last.  We were getting denials, because the diagnoses were the same as the hospitalists.  so we started coding Z51.5 in the first position, and then the other sign/symptoms/diagnosis additionally.  At first we thought you could not use Z51.5 in the first position, but then reading in more depth, yes you can use it first, but you must add additional diagnoses.  we are not getting any denials now.  hope that helps.

Annette W.  CPC, CEMC
Profee Coder
Minnesota


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## HeidiL212 (Jun 4, 2020)

Hi, I was wondering if anyone has some kind of superbill for Palliative visits that they use and if they would be willing to share?


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