A Do Not Resuscitate (DNR) order is a patient’s formal, legally recognized instruction to healthcare providers to withhold cardiopulmonary resuscitation (CPR) if cardiac or respiratory arrest occurs. This order is a central component of advance care planning, allowing individuals to maintain autonomy over their medical treatment preferences. Although the order is a medical directive, it must be documented and coded within the healthcare system. This ensures all members of the care team are aware of the patient’s wishes and communicates the patient’s status across medical records and billing systems.
The Clinical Scope of a DNR Order
A DNR order is a specific instruction addressing the refusal of cardiopulmonary resuscitation (CPR) if a person’s heart stops or they stop breathing. This directive prohibits interventions like chest compressions, electrical defibrillation, and advanced airway procedures such as intubation and mechanical ventilation. The order prevents the use of invasive, often burdensome measures that may offer little benefit, particularly for patients with terminal illnesses or advanced frailty.
It is a common misunderstanding that a DNR order means “do not treat,” but this is inaccurate. The order does not prohibit any other forms of medical care, including treatment for underlying conditions, diagnostic testing, or surgical procedures. Patients with a DNR order will still receive full medical attention, such as antibiotics for an infection, pain medication for comfort, and palliative care services. The focus of care shifts from aggressive life-prolonging measures to maintaining comfort and quality of life.
The medical team continues to treat all other symptoms and conditions, ensuring the patient is not provided substandard care. The order is a specific limitation on a single set of emergency procedures, not a blanket refusal of all medical intervention. A DNR designation allows a person to choose a peaceful, natural death without the trauma of resuscitation attempts.
Establishing the Order: Legal Requirements and Documentation
A DNR order is a formal medical order documented by a physician or other authorized healthcare provider, distinguishing it from a general living will or advance directive. The process typically begins with a detailed discussion between the patient and their provider about the expected outcomes of CPR given the patient’s current health status. The patient must have the mental capacity to consent to the order, or, if they lack capacity, a legally appointed surrogate decision-maker must make the decision on their behalf.
The requirements for a valid DNR order are subject to state law, and documentation procedures often differ for care provided inside and outside a hospital setting. In-hospital DNRs are typically placed directly into the patient’s electronic medical record and chart. For out-of-hospital scenarios, which involve Emergency Medical Services (EMS) personnel, many states use specialized, standardized forms like a Physician Order for Life-Sustaining Treatment (POLST) or Medical Orders for Life-Sustaining Treatment (MOLST).
These state-specific, portable medical orders are designed to travel with the patient and provide clear, immediately actionable instructions to all emergency and non-emergency healthcare providers. Unlike a living will, which is a generalized expression of wishes, a DNR or POLST form is a physician’s order that must be followed. The documentation usually requires the signatures of the patient or their surrogate, the attending physician, and sometimes witnesses to ensure legal validity.
How Medical Coding Relates to DNR
Medical coding is an administrative necessity in healthcare, and the DNR status is formally documented using a specific code from the International Classification of Diseases, Tenth Revision, Clinical Modification (ICD-10-CM). The code assigned to a “Do not resuscitate” status is Z66. This code is part of Chapter 21, which includes factors influencing health status and contact with health services, rather than a code for a disease or injury.
The Z66 code is a billable code that serves administrative and statistical purposes within the healthcare system. It ensures consistent record-keeping and appropriate statistical tracking of patient preferences and outcomes across different facilities. The presence of the Z66 code in the patient’s record alerts medical coders and billers to the patient’s status, which is important for documentation and reimbursement processes.
The ICD-10 code itself is not the medical order that directs immediate patient care; that is the function of the physician’s signed DNR order. Instead, the Z66 code is a standardized administrative tag that reflects the existence of this directive. Accurate coding of the DNR status is a documentation requirement to maintain compliance and ensure the patient’s wishes are reflected in their official medical records.