Mr. Jones is an 86-year-old man with severe COPD and lung cancer.  He presents to your palliative medicine clinic today for follow-up.  He has opted to cluster his appointments today before he goes out of town for the weekend.  He is going to see his oncologist and pulmonologist later today.  Of the following, which is the best diagnosis code (ICD-10) to use for the visit?

A. Dypsnea (R06.0)
B. Small Cell Lung Cancer (C34.90)
C. Severe COPD (J44.9)
D. History of Radiation Therapy (Z92.3)

Correct Answer: A


When billing for a visit on the same day as other providers, it is necessary that each physician document a legitimate need which is distinct from those addressed by the other providers who are seeing the patient that day. As a palliative care provider, this can be easily accomplished by selecting the symptom being treated such as neoplasm-related pain or dyspnea.  These are unlikely to be selected by the other providers as the primary diagnosis for the day (i.e. the oncologist will likely choose small cell lung cancer, and the pulmonologist is likely to select COPD). 

Fast Facts and Concepts #48.   Coding and Billing For Physician Services In Palliative Care.