Made a technical update to this LCD to remove the empty Coding Information fields. Critically impaired breathing capacity as demonstrated by all the following characteristics occurring within the 12 months preceding initial hospice certification: Vital capacity (VC) less than 30% of normal (if available); Patient declines mechanical ventilation; external ventilation used for comfort measures only. THE UNITED STATES GOVERNMENT AND ITS EMPLOYEES ARE NOT LIABLE FOR ANY ERRORS, OMISSIONS, OR OTHER INACCURACIES IN Made a technical update to this LCD, to remove the empty Coding Information fields. Patients with dementia should show all the following characteristics: Stage seven or beyond according to the Functional Assessment Staging Scale; Urinary and fecal incontinence, intermittent or constant; No consistently meaningful verbal communication: stereotypical phrases only or the ability to speak is limited to six or fewer intelligible words. Clin Cardiol. Part II. Progressive decline in Functional Assessment Staging (FAST) for dementia (from 7A on the FAST). CMS WILL NOT BE LIABLE FOR ANY CLAIMS ATTRIBUTABLE TO ANY ERRORS, OMISSIONS, OR OTHER INACCURACIES IN THE INFORMATION OR MATERIAL CONTAINED ON THIS PAGE. Intractable hyperkalemia (> 7.0) not responsive to treatment; Intractable fluid overload, not responsive to treatment. Annals of Internal Medicine. You can use the Contents side panel to help navigate the various sections. Patients with advanced structural heart disease and marked symptoms of HF at rest despite maximal medical therapy and who require specialized interventions. For example, severe protein-calorie malnutrition cannot be considered a MCC for the principle diagnosis of "Failure to Thrive" because the two conditions are too similar. CMS and its products and services are not endorsed by the AHA or any of its affiliates. These guidelines are to be used in conjunction with the Non-disease specific baseline guidelines described in Part II. Use is limited to use in Medicare, Medicaid or other programs administered by the Centers for Medicare and Medicaid Services (CMS). Please review and accept the agreements in order to view Medicare Coverage documents, which may include licensed information and codes. 0000017107 00000 n Documentation of the following factors will support eligibility for hospice care: Chronic persistent diarrhea for one year; Absence of or resistance to effective antiretroviral, chemotherapeutic and prophylactic drug therapy related specifically to HIV disease; Congestive heart failure, symptomatic at rest; Prothrombin time prolonged more than 5 seconds over control, or International Normalized Ratio (INR) > 1.5; End stage liver disease is present and the patient shows at least one of the following: Ascites, refractory to treatment or patient non-compliant; Hepatorenal syndrome (elevated creatinine and BUN with oliguria (< 400 ml/day) and urine sodium concentration < 10 mEq/l); Hepatic encephalopathy, refractory to treatment, or patient non-compliant; Recurrent variceal bleeding, despite intensive therapy. Dyspnea or fatigue due to left ventricular systolic dysfunction; asymptomatic patients who are undergoing treatment for prior symptoms of HF. The document is broken into multiple sections. OR Hypercapnia, as evidenced by pCO2 50 mmHg. ), Patients will be considered to be in the terminal stage of pulmonary disease (life expectancy of six months or less) if they meet the following criteria. ge"^WOgr |___W+ tpIht=hozGC8 (This value may be obtained from recent [within 3 months] hospital records.). 0000003947 00000 n (1 and 2 should be present; factors from 3 will add supporting documentation. Extent and determinants of error in doctors prognoses in terminally ill patients: prospective cohort study. ), Stroke and ComaPatients will be considered to be in the terminal stages of stroke or coma (life expectancy of six months or less) if they meet the following criteria:Stroke, The guidelines contained in this policy are intended to help providers determine when patients are appropriate for the Medicare Hospice benefit. Documentation of 3, 4, and 5, will lend supporting documentation. been made to provide accurate and complete information, CMS does not guarantee that there are no errors in the information displayed Any use not authorized herein is prohibited, including by way of illustration and not by way of limitation, making copies of CPT for resale and/or license, transferring copies of CPT to any party not bound by this agreement, creating any modified or derivative work of CPT, or making any commercial use of CPT. To capture use of hypocaloric PN dosing. The scope of this license is determined by the AMA, the copyright holder. If an entity wishes to utilize any AHA materials, please contact the AHA at 312‐893‐6816. End Users do not act for or on behalf of the CMS. and the State Children's Health Insurance Programs, contracts with certain organizations to assist in the administration of the If an entity wishes to utilize any AHA materials, please contact the AHA at 312‐893‐6816. The views and/or positions presented in the material do not necessarily represent the views of the AHA. (Should fulfill 1, 2, or 3). Diurnal rhythm frequently disturbed. CPT is provided "as is" without warranty of any kind, either expressed or implied, including but not limited to, the implied warranties of merchantability and fitness for a particular purpose. Speech ability declines to about a half-dozen intelligible words. ), Hypoxemia at rest on room air, as evidenced by pO2 less than or equal to 55 mmHg, or oxygen saturation less than or equal to 88%, determined either by arterial blood gases or oxygen saturation monitors, (these values may be obtained from recent hospital records) OR hypercapnia, as evidenced by pCO2 greater than or equal to 50 mmHg. Hospice Eligibility Criteria Patient has a terminal illness with a life . 0000014923 00000 n preparation of this material, or the analysis of information provided in the material. malnutrition (263.0: Malnutrition of a Moderate Degree) and severe malnutrition (262: Other Severe Protein Calorie Malnutrition). R2Revision Effective: N/ARevision Explanation: Annual review no changes made. 0000159154 00000 n special, incidental, or consequential damages arising out of the use of such information, product, or process. E46 is a billable/specific ICD-10-CM code that can be used to indicate a diagnosis for reimbursement purposes. Language quoted from Centers for Medicare and Medicaid Services (CMS), National Coverage Determinations (NCDs) and coverage provisions in interpretive manuals is italicized throughout the policy. This policy describes guidelines to be used by Home Health & Hospice (HH&H) MAC in reviewing hospice claims and by hospice providers to determine eligibility of beneficiaries for hospice benefits. (1 and either 2, 3 or 4 should be present. LCDs are specific to an item or service (procedure) and they define the specific diagnosis (illness or injury) for which the item or service is covered. 0000017875 00000 n 0000005335 00000 n Patients will be considered to have a life expectancy of six months or less if there is documented evidence of decline in clinical status based on the guidelines listed below. (Optimally treated means that patients who are not on vasodilators have a medical reason for refusing these drugs, e.g., hypotension or renal disease.). Neither the United States Government nor its employees represent that use of Applicable Federal Acquisition Regulation Clauses (FARS)/Department of Defense Federal Acquisition Regulation supplement (DFARS) Restrictions Apply to Government Use. If a patient improves or stabilizes sufficiently over time while in hospice such that he/she no longer has a prognosis of six months or less from the most recent recertification evaluation or definitive interim evaluation, that patient should be considered for discharge from the Medicare hospice benefit. If any physical activity is undertaken, discomfort is increased.) License to use CPT for any use not authorized herein must be obtained through the AMA, CPT Intellectual Property Services, AMA Plaza 330 N. Wabash Ave., Suite 39300, Chicago, IL 60611-5885. 0000040363 00000 n Reproduced with permission. The two main criteria are the American Society for Parenteral and Enteral Nutrition (ASPEN) and the Global Leadership Initiative on Malnutrition (GLIM). and/or making any commercial use of UB‐04 Manual or any portion thereof, including the codes and/or descriptions, is only The brain appears to no longer be able to tell the body what to do. > LCDs outline how the contractor will review claims to ensure that the services provided meet Medicare coverage requirements. Critical nutritional impairment as demonstrated by all the following characteristics occurring within the 12 months preceding initial hospice certification: Oral intake of nutrients and fluids insufficient to sustain life; Absence of artificial feeding methods, sufficient to sustain life, but not for relieving hunger. RegVUA]rj N{ 8Qs. Dysphagia leading to recurrent aspiration and/or inadequate oral intake documented by decreasing food portion consumption. %%EOF hbbRc`b``3 1x4>.0 Progressive loss of abilities to walk, sit up, smile, and hold head up. C. Heart Disease. There are multiple ways to create a PDF of a document that you are currently viewing. License to use CDT for any use not authorized herein must be obtained through the American Dental Association, 211 East Chicago Avenue, Chicago, IL 60611. The AMA assumes no liability for data contained or not contained herein. If you would like to extend your session, you may select the Continue Button. The use of the Karnofsky Performance Scale in determining outcomes and risk in geriatric outpatients. If a patient improves and/or stabilizes sufficiently over time while in hospice such that he/she no longer has a prognosis of six months or less from the most recent recertification evaluation or definitive interim evaluation, that patient should be considered for discharge from the Medicare hospice benefit. No specific number of variables must be met, but fewer of those listed first (more predictive) and more of those listed last (least predictive) would be expected to predict longevity of six months or less. Since determination of decline presumes assessment of the patients status over time, it is essential that both baseline and follow-up determinations be reported where appropriate. Examination by a neurologist within three months of assessment for hospice is advised, both to confirm the diagnosis and to assist with prognosis. E40 refers to Kwashiorkor is severe malnutrition with nutritional edema and dyspigmentation of skin and hair. Alzheimer's disease and other progressive dementias are life-altering and eventually fatal conditions for which curative therapy is not available. Recertification for hospice care requires the same clinical standards be met as for initial certification, but they need not be reiterated. Unintentional progressive weight loss of greater than 10% of body weight over the preceding six months. Annals of Internal Medicine 2001; 134; 1097-1143. The Social Security Act, Sections 1869(f)(2)(B) and 1862(l)(5)(D) define LCDs and provide information on the process. Patients with chronic lung disease, long term survival in hospice, or apparent stability can still be eligible for hospice benefits, but sufficient justification for a less than six month prognosis should appear in the record.If the documentation includes any findings inconsistent with or tending to disprove a less than 6-month prognosis, they should be answered or refuted by other entries, or specifically addressed and explained. Reproduced with permission. The American Hospital Association ("the AHA") has not reviewed, and is not responsible for, the completeness or accuracy of any information contained in this material, nor was the AHA or any of its affiliates, involved in the preparation of this material, or the analysis of information provided in the material. All billing and coding information was previously moved to the related Billing and Coding Article, A52830. Physiologic impairment of functional status as demonstrated by: Dependence on assistance for two or more activities of daily living (ADLs), Neurologic disease (CVA, ALS, MS, Parkinsons). Inability to maintain sufficient fluid and calorie intake with 10% weight loss during the previous six months or serum albumin <2.5 gm/dl . No objective deficits in employment or social situations. Such patients can be re-enrolled for a new benefit period when a decline in their clinical status is such that their life expectancy is again six months or less.
Broughton Hospital Famous Patients,
Jaclyn Swartz Chicago,
Callaway Epic Max 3 Wood Adjustment Guide,
Chopsticks Express Nutrition,
Articles P
