Oncology & Hematology Coding Alert

The new code set has its own V66.7, but its definition may surprise you.

Coding for palliative care under ICD-10-CM will be similar to coding under ICD-9-CM, but there are some subtleties you need to watch for. These tips will help you prepare for potential sequencing and miscoding trouble spots.

ICD-9-CM Code

• V66.7, Encounter for palliative care

ICD-10-CM Codes

• Z51.5, Encounter for palliative care

ICD-9-CM coding rules: Notes with ICD-9-CM code V66.7 state it's appropriate for end-of-life care, hospice care, and terminal care. There is also an instruction to "Code first underlying disease."

ICD-10-CM changes: ICD-10-CM has a similar instruction to "Code also condition requiring care." According to ICD-10-CM official guidelines, the "code also" note does not provide sequencing instructions. "The sequencing of the two codes is discretionary, depending on the severity of the conditions and the reason for the encounter," ICD-10-CM instructs. When the new code set is implemented, watch payer policies for specific instructions.

Documentation: To ensure proper coding of palliative care, the physician needs to document both the condition being treated at the encounter and the decision to proceed using palliative care.

Coder tips: When ICD-10-CM becomes effective, take care not to report V66.7 for palliative care. ICD-10-CM includes its own V66.7 (Person on outside of heavy transport vehicle injured in collision with other nonmotor vehicle in traffic accident). Nonmotor vehicles include animal-drawn vehicles, animals being ridden, and streetcars. ICD-10-CM's V66.7 requires a seventh character:

• A, initial encounter
• D, subsequent encounter
• S, sequela.

ICD-10-CM uses "X" as a placeholder when codes with less than seven characters require a seventh digit. For instance, for the initial encounter the appropriate ICD-10-CM code would be V66.7XXA.

Remember: When ICD-10-CM goes into effect, you should apply the code set and official guidelines in effect for the date of service reported. Learn more at www.cms.gov/ICD10/ and www.cdc.gov/nchs/icd/icd10cm.htm#10update. HHS Secretary, Kathleen Sebelius, issued a press release announcing the delayed implementation date Oct. 1, 2014. The comment period is now closed, and public comments are being reviewed and analyzed. The department is expected to issue the final rule soon.