AHA Coding Clinic® for ICD-9 - 2008 Issue 3; Ask the Editor

Palliative Care

An elderly patient with metastatic lung carcinoma is admitted with fever and chills and is diagnosed with pneumonia and urinary tract infection. The principal diagnosis is pneumonia. During the hospitalization, the patient develops severe sepsis and respiratory failure requiring a ventilator. On the day before the patient expires, she is extubated and taken off of Levophed. On the day she expired, the physician documented, “extubated yesterday with goals of comfort/palliative care.” In addition, the physician’s plan states, “Continue palliative approach to respiratory failure––increase Morphine to limit work of breathing, stop intensive monitoring, consult palliative care service, continue scopolamine.” The patient expired an hour after this note was written. Is it appropriate to assign code V66.7, Encounter for palliative care, as a secondary diagnosis in this situation? ...

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