Significant congestive heart failure may be documented by an ejection fraction of less than or equal to 20%, but is not required if not already available. 4 Methodologies to Determine Hospice Eligibility Meets Local Coverage Determinations (LCD) Meets most LCD guidelines and documented decline Meets most LCD guidelines and additional co-morbidities Physician's clinical judgment Guidelines & Indicators General Guidelines Non-specific Disease Guidelines International Classification of Functioning Please note that codes (CPT/HCPCS and ICD-10) have moved from LCDs to Billing & Coding Articles. It places patients in one of four categories, based on how much they are limited during physical activity: patients with no limitation of activities; they suffer no symptoms from ordinary activities. First, make sure the malnutrition meets the definition of a secondary diagnosisi.e., is there evaluation, monitoring, treatment, increased nursing care and/or increased length of stay. ), Liver DiseasePatients will be considered to be in the terminal stage of liver disease (life expectancy of six months or less) if they meet the following criteria. Progressive stage 3-4 pressure ulcers in spite of optimal care. Baker D, Chin M, Cinquigrani M, et al. PMID . Current Dental Terminology © 2022 American Dental Association. No fee schedules, basic unit, relative values or related listings are included in CPT. 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. You agree to take all necessary steps to ensure that your employees and agents abide by the terms of this agreement. Fee schedules, relative value units, conversion factors and/or related components are not assigned by the AMA, are not part of CPT, and the AMA is not not endorsed by the AHA or any of its affiliates. The Palliative Performance Scale (PPS) is a modification of the Karnofsky Performance Scale intended for evaluating patients requiring palliative care. The AMA is a third party beneficiary to this Agreement. 0000040080 00000 n Abnormal brain stem response The score can help determine which patients can be managed in the home and which should be admitted to a hospice unit. It was adopted by the Center for Medicare and Medicaid Services (CMS) as part of the Hospital Inpatient Quality Reporting Program and will go into effect in 2024. 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. "JavaScript" disabled. The information displayed in the Tracking Sheet is pulled from the accompanying Proposed LCD and its correlating Final LCD and will be updated as new data becomes available. 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). Recurrent or intractable serious infections such as pneumonia, sepsis or pyelonephritis; Weight loss of at least 10% body weight in the prior six months, not due to reversible causes such as depression or use of diuretics; Decreasing anthropomorphic measurements (mid-arm circumference, abdominal girth), not due to reversible causes such as depression or use of diuretics; Observation of ill-fitting clothes, decrease in skin turgor, increasing skin folds or other observation of weight loss in a patient without documented weight; Dysphagia leading to recurrent aspiration and/or inadequate oral intake documented by decreasing food portion consumption. Factors from 3 will add supporting documentation. Each type may be classified as acute or chronic. (Documentation of serial decrease of FEV1>40 ml/year is objective evidence for disease progression, but is not necessary to obtain. Additionally, marasmus can precede kwashiorkor. The Social Security Act, Sections 1869(f)(2)(B) and 1862(l)(5)(D) define LCDs and provide information on the process. (1 and 2 should be present; factors from 3 will add supporting documentation. 0000000016 00000 n Organizations who contract with CMS acknowledge that they may have a commercial CDT license with the ADA, and that use of CDT codes as permitted herein for the administration of CMS programs does not extend to any other programs or services the organization may administer and royalties dues for the use of the CDT codes are governed by their commercial license. Muscle wasting with reduced strength and endurance; Continued active alcoholism (> 80 gm ethanol/day); Hepatitis C refractory to interferon treatment. Goal: 90%. Alzheimer's disease and other progressive dementias are life-altering and eventually fatal conditions for which curative therapy is not available. Coverage Indications, Limitations, and/or Medical Necessity. This page displays your requested Local Coverage Determination (LCD). (1 and either 2, 3 or 4 should be present. Lupus or Rheumatoid Arthritis). There are multiple ways to create a PDF of a document that you are currently viewing. AJ Hospice & Palliative Care. No memory deficit evident on clinical interviews. Patients will be considered to be in the terminal stage of heart disease (life expectancy of six months or less) if they meet the following criteria. Factors from 3 will add supporting documentation. Medicare coverage of hospice depends on a physicians certification that an individuals prognosis is a life expectancy of six months or less if the terminal illness runs its normal course. 0000005794 00000 n FAST scale. The license granted herein is expressly conditioned upon your acceptance of all terms and conditions contained in this agreement. hb``g``og`e`8 @1v'00?07)&=y a"WF9e*())vt4xLJJ 6x5;E8X>0~b !a;"cCm)'01d93f00,a``VF? o000h36(`a`h'a~6AAj@Ae\T@6 M> 0000022017 00000 n Hospitals Overbilled Medicare $1 Billion by Incorrectly Assigning 0000010879 00000 n Laboratory tests in protein-calorie malnutrition - PubMed Documentation of the following factors will support but is not required to establish eligibility for hospice care: Treatment resistant symptomatic supraventricular or ventricular arrhythmias; History of cardiac arrest or resuscitation; CD4+ Count 100,000 copies/ml, plus one of the following: Untreated, or persistent despite treatment, wasting (loss of at least 10% lean body mass); Mycobacterium avium complex (MAC) bacteremia, untreated, unresponsive to treatment, or treatment refused; Progressive multifocal leukoencephalopathy; Systemic lymphoma, with advanced HIV disease and partial response to chemotherapy; Visceral Kaposis sarcoma unresponsive to therapy; Renal failure in the absence of dialysis; Decreased performance status, as measured by the Karnofsky Performance Status (KPS) scale, of 50%. 2004;7(1):47-53. The A.S.P.E.N. Before an LCD becomes final, the MAC publishes Proposed LCDs, which include a public comment period. Part I. %PDF-1.4 % The responsibility for the content of this file/product is with CMS and no endorsement by the AMA is intended or implied. without the written consent of the AHA. Weight loss not due to reversible causes such as depression or use of diuretics, Decreasing anthropomorphic measurements (mid-arm circumference, abdominal girth), not due to reversible causes such as depression or use of diuretics. Patients are considered eligible for Hospice care if they do not elect tracheostomy and invasive ventilation and display evidence of critically impaired respiratory function (with or without use of NIPPV) and / or severe nutritional insufficiency (with or without use of a gastrostomy tube). CMS and its products and services are Please review and accept the agreements in order to view Medicare Coverage documents, which may include licensed information and codes. If other clinical indicators of decline not listed in this policy such as psychological and spiritual factors form the basis for certifying terminal status, they should be documented as well. These materials contain Current Dental Terminology (CDTTM), copyright© 2022 American Dental Association (ADA). These should be documented in the clinical record. Protein-Energy Malnutrition | Nutrition Guide for Clinicians special, incidental, or consequential damages arising out of the use of such information, product, or process. 1973 May 12;1(7811):1041-2. The Centers for Medicare & Medicaid Services (CMS), the federal agency responsible for administration of the Medicare, Medicaid Therefore, multiple clinical parameters are required to judge the progression of ALS. Hepatic encephalopathy, refractory to treatment, or patient non-compliant; Recurrent variceal bleeding, despite intensive therapy. Patients who are frequently hospitalized for HF or cannot be safely discharged from the hospital; patients in the hospital awaiting heart transplantation; patients at home receiving continuous intravenous support for symptom relief or being supported with a mechanical circulatory assist device; patients in a hospice setting for management of HF. Some patients may not meet these guidelines, yet still have a life expectancy of 6 months or less. 708 0 obj <>stream If you do not agree with all terms and conditions set forth herein, click below on the button labeled "I do not accept" and exit from this computer screen. Christakis N, Lamont E. Extent and determinants of error in doctors prognoses in terminally ill patients: prospective cohort study. Inability to maintain hydration and caloric intake with one of the following: Weight loss > 10% in the last 6 months or > 7.5% in the last 3 months; Current history of pulmonary aspiration not responsive to speech language pathology intervention; Sequential calorie counts documenting inadequate caloric/fluid intake; Dysphagia severe enough to prevent patient from continuing fluids/foods necessary to sustain life and patient does not receive artificial nutrition and hydration. Some patients decline rapidly and die quickly; others progress more slowly. Note: This section is specific for Alzheimers disease and Related Disorders, and is not appropriate for other types of dementia.Heart DiseasePatients will be considered to be in the terminal stage of heart disease (life expectancy of six months or less) if they meet the following criteria.