Center to Advance Palliative Care

We recently became aware that this post had not been responded to. I asked some of our financial and consultant pros to repond. I have copied their responses below.
Sharol Herr, RN, BSN, MSEd; Nurse Clinician/Education Coordinator; Mount Carmel Health Palliative Care Leadership Center.

I have to say, I know little about what Medpar does with the codes. I am virtually certain that the V66.7 has little/nothing to do with how much providers get paid. It really provides additional info to go along with the regular ICD-9 dx. I don't think it in any way bumps up the CPT/fee. I think the fellow Brian was corresponding with confirmed that it is not used for risk adjustment for mortality stats; that is done with a different methodology.

Regarding the question of the position in which the Vcode should be listed, some of the correspondence we have seen says that only 4 dx are pulled by some of the billing software. That would suggest that V66.7 should be no lower than 4th if they want to be sure it is submitted. The MCW code positioning would support this. Of course it may vary depending on the billing software.
Nancy Henley

On Mon, Sep 8, 2008 at 11:31 AM, Brian Cassel
Virginia Commonwealth University

I don't understand the premise of "If we are supposed to be using the V

code for CMS to determine if any additional money will be available for

this code..." Is CMS considering paying docs or hospitals more for doing
PC? I can't imagine, but who knows...

Currently the use of V66.7 as a means of documenting PC consults or hospice
assessments suffers from both sins of commission and omission-- coders may
invoke it even when PC and hospice are not involved, and it might not be
used even when PC and hospice are heavily involved. Thus there is not much
chance that CMS or other entities will be able to draw good conclusions
from the frequency of this code being used, given its inexact use.

I agree with Julie that this question of codes being dropped for physician
billing (where some billing systems have a max of 4 codes for example) is
quite different from facility billing (where the max is in the double
digits).

I don’t believe it impacts billing; however we try to always get it listed in the 2-4 position so it doesn’t get left off. I’m not sure why providers would have 11 or 12 diagnoses listed for a palliative care visit anyway? I would think the signs/symptoms or cancer related pain would be first, chronic illness causing need for palliative care would be second and V66.7 could be third maybe fourth. Ending up with 12 diagnoses sounds like it is facility coding not physician.



Julie Pipke, CPC

Reimbursement Manager, Medicine

Medical College of Wisconsin