Validation of the V66.7 Code for Palliative Care Consultation in a Single Academic Medical Center

Hua, May; Li, Guohua; Clancy, Caitlin B.; Morrison, R. Sean; Wunsch, Hannah

doi:10.1089/jpm.2016.0363

Cited by 122 publications

(104 citation statements)

References 17 publications

(17 reference statements)

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“…In this study, 15% of patients with any frailty received billing for inpatient palliative care during their surgical hospitalization, which is higher than in other acutely ill older surgical patients . A limitation of administrative data is that coding for palliative care underrepresents the actual delivery of primary palliative care . However, given the high rates of mortality, institutional discharge, and healthcare utilization after EGS among older patients with frailty, palliative care should be routinely provided by members of the perioperative team to all of these patients as suggested by national consensus guidelines for quality palliative care endorsed by the American College of Surgeons…”

Section: Discussionmentioning

confidence: 99%

The Impact of Frailty on Long‐Term Patient‐Oriented Outcomes after Emergency General Surgery: A Retrospective Cohort Study

Lee

Streid

Sturgeon

et al. 2020

J American Geriatrics Society

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OBJECTIVES: Few studies examine the impact of frailty on long-term patient-oriented outcomes after emergency general surgery (EGS). We measured the prevalence of frailty among older EGS patients and examined the impact of frailty on 1-year outcomes. DESIGN: Retrospective cohort study using 2008 to 2014 Medicare claims. SETTING: Acute care hospitals. PARTICIPANTS: Patients 65 years or older who received one of the five EGS procedures with the highest mortality burden (partial colectomy, small bowel resection, peptic ulcer disease repair, adhesiolysis, or laparotomy). MEASUREMENTS: A validated claims-based frailty index (CFI) identified patients who were not frail (CFI < .15), prefrail (.15 ≤ CFI < .25), mildly frail (.25 ≤ CFI < .35), and moderately to severely frail (CFI ≥ .35). Multivariable Cox regression compared 1-year mortality. Multivariable Poisson regression compared rates of post-discharge hospital encounters (hospitalizations, intensive care unit stay, emergency department visit) and home time over 1 year after discharge. All regression models adjusted for age, sex, race, admission from facility, procedure, sepsis, inpatient palliative care delivery, trauma center designation, hospital bed size, and teaching status, and they were clustered by patient and hospital referral region. RESULTS: Among 468 459 older EGS adults, 37.4% were pre-frail, 12.4% were mildly frail, and 3.6% were moderately to severely frail. Patients with mild frailty experienced a higher risk of 1-year mortality compared with non-frail patients (hazard ratio = 1.97; confidence interval [CI] = 1.94-2.01). In the year after discharge, patients with mild and moderate to severe frailty had more hospital encounters compared with non-frail patients (7.8 and 11.5 vs 2.0 per person-year; incidence rate ratio [IRR] = 4.01; CI = 3.93-4.08 vs IRR = 5.89; CI = 5.70-6.09, respectively). Patients with mild and moderate to severe frailty also had fewer days at home in the year after discharge compared with non-frail patients (256 and 203 vs 302 mean days; IRR = .97; CI = .96-.97 vs IRR = .95; CI = .94-.95, respectively). CONCLUSION: Older EGS patients with frailty are at increased risk for poor 1-year outcomes and decreased home time. Targeted interventions for older EGS patients with frailty during the index EGS hospitalization are urgently needed to improve long-term outcomes.

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Section: Discussionmentioning

confidence: 99%

The Impact of Frailty on Long‐Term Patient‐Oriented Outcomes after Emergency General Surgery: A Retrospective Cohort Study

Lee

Streid

Sturgeon

et al. 2020

J American Geriatrics Society

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“…First, identifying palliative care in claims data is not straightforward. Studies of palliative care in patients with cancer using billing data thus far have relied on ICD‐9 codes , which lack sensitivity and encompass a wide range of services . Additionally, ICD‐9 codes are not specific for subspecialty palliative care.…”

Section: Discussionmentioning

confidence: 99%

“…We believe that physician specialty codes, as opposed to International Classification of Diseases, 9th Revision (ICD‐9) billing codes (V66.7, ‘encounter for palliative care’), provide a more accurate estimate of palliative care use. Also, using ICD‐9 codes is suboptimal due to a poor sensitivity of 19–50% and its broad range of related services, such as hospice and ‘terminal care’ .…”

Section: Methodsmentioning

confidence: 99%

Palliative care use amongst patients with bladder cancer

et al. 2019

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ObjectivesTo describe the rate and determinants of palliative care use amongst Medicare beneficiaries with bladder cancer and encourage a national dialogue on improving coordinated urological, oncological, and palliative care in patients with genitourinary malignancies. Patients and methodsUsing Surveillance, Epidemiology, and End Results-Medicare data, we identified patients diagnosed with muscle-invasive bladder cancer (MIBC) between 2008 and 2013. Our primary outcome was receipt of palliative care, defined as the presence of a claim submitted by a Hospice and Palliative Medicine subspecialist. We examined determinants of palliative care use using logistic regression analysis. ResultsOver the study period, 7303 patients were diagnosed with MIBC and 262 (3.6%) received palliative care. Of 2185 patients with advanced bladder cancer, defined as either T4, N + , or M + disease, 90 (4.1%) received palliative care. Most patients that received palliative care (>80%, >210/262) did so within 24 months of diagnosis. On multivariable analysis, patients receiving palliative care were more likely to be younger, female, have greater comorbidity, live in the central USA, and have undergone radical cystectomy as opposed to a bladder-sparing approach. The adjusted probability of receiving palliative care did not significantly change over time. ConclusionsPalliative care provides a host of benefits for patients with cancer, including improved spirituality, decrease in diseasespecific symptoms, and better functional status. However, despite strong evidence for incorporating palliative care into standard oncological care, use in patients with bladder cancer is low at 4%. This study provides a conservative baseline estimate of current palliative care use and should serve as a foundation to further investigate physician-, patient-, and system-level barriers to this care.Keywords urinary bladder neoplasms, palliative care, palliative medicine, cystectomy, quality of health care, health services research, Medicare, #BladderCancer, #blcsm

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“…Recent work by Hua et al . found that, in a single centre, sensitivity and specificity of the V667 code for detecting a PC visit were 49.9% and 99.1%, respectively . This suggests that the code likely underestimates the true incidence of PC involvement.…”

Section: Discussionmentioning

confidence: 99%

Inpatient palliative care referral and 9‐month hospital readmission in patients with congestive heart failure: a linked nationwide analysis

et al. 2017

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Validation of the V66.7 Code for Palliative Care Consultation in a Single Academic Medical Center

Abstract: In a single center, the ICD-9 code V66.7 had poor sensitivity and high specificity for identifying hospitalized patients who received a palliative care consultation. Appropriate use of this code for this purpose should take these characteristics into consideration.

Cited by 122 publications

References 17 publications

The Impact of Frailty on Long‐Term Patient‐Oriented Outcomes after Emergency General Surgery: A Retrospective Cohort Study

The Impact of Frailty on Long‐Term Patient‐Oriented Outcomes after Emergency General Surgery: A Retrospective Cohort Study

Palliative care use amongst patients with bladder cancer

Inpatient palliative care referral and 9‐month hospital readmission in patients with congestive heart failure: a linked nationwide analysis

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