In no event shall CMS be liable for direct, indirect, special, incidental, or consequential damages arising out of the use of such information or material. CMS believes that the Internet is an effective method to share LCDs that Medicare contractors develop. The two main criteria are the American Society for Parenteral and Enteral Nutrition (ASPEN) and the Global Leadership Initiative on Malnutrition (GLIM). 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. 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. This is the American ICD-10-CM version of E43 - other international versions of ICD-10 E43 may differ. Q&A: Review clinical criteria for malnutrition | ACDIS Geriatric Failure to Thrive | AAFP THE INFORMATION, PRODUCT, OR PROCESSES DISCLOSED HEREIN. 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). However, documentation expectations should comport with normal clinical documentation practices. The views and/or positions presented in the material do not necessarily represent the views of the AHA. ), Patients 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. THE UNITED STATES GOVERNMENT AND ITS EMPLOYEES ARE NOT LIABLE FOR ANY ERRORS, OMISSIONS, OR OTHER INACCURACIES IN Disease-specific guidelines for hospice - UpToDate The patient is not seeking dialysis or renal transplant, or is discontinuing dialysis; As with any other condition, an individual with renal disease is eligible for the Hospice benefit if that individual has a prognosis of six months or less, if the illness runs its normal course. Malnutrition, Obesity and BMI : Medical Coding Guidelines CPT codes, descriptions and other data only are copyright 2022 American Medical Association. 0000009983 00000 n 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. 0000001970 00000 n The use of the Karnofsky Performance Scale in determining outcomes and risk in geriatric outpatients. Progression of disease differs markedly from patient to patient. No objective deficits in employment or social situations. Section 322 of BIPA amended section 1814(a) of the Social Security Act by clarifying that the certification of an individual who elects hospice "shall be based on the physician's or medical director's clinical judgment regarding the normal course of the individual's illness.'' All verbal abilities are lost. Protein calorie malnutrition, nutritional intervention and personalized cancer care Authors Anju Gangadharan 1 , Sung Eun Choi 2 , Ahmed Hassan 1 , Nehad M Ayoub 3 , Gina Durante 4 , Sakshi Balwani 1 , Young Hee Kim 4 , Andrew Pecora 5 , Andre Goy 5 , K Stephen Suh 1 Affiliations The CMS.gov Web site currently does not fully support browsers with Normal activity & work No evidence of disease, Normal activity & work Some evidence of disease, Normal activity with effort Some evidence of disease, Unable Normal Job/Work Significant disease, Unable hobby/house work Significant disease, Unable to do most activity Extensive disease, Unable to do any activity Extensive disease, Detailed Description of Each of the 7 Stages. + If you would like to extend your session, you may select the Continue Button. 646 0 obj <> endobj Some patients may not meet these guidelines, yet still have a life expectancy of six months or less. This LCD describes guidelines to be used by National Government Services (NGS) in reviewing hospice claims and by hospice providers to determine eligibility of beneficiaries for hospice benefits. The lower the Karnofsky score, the worse the survival for most serious illnesses.KARNOFSKY PERFORMANCE STATUS SCALE DEFINITIONS RATING (%) CRITERIA. Any use not authorized herein is prohibited, including by way of illustration and not by way of limitation, making copies of CDT for resale and/or license, transferring copies of CDT to any party not bound by this agreement, creating any modified or derivative work of CDT, or making any commercial use of CDT. descriptions may not be removed, copied, or utilized within any software, product, service, solution or derivative work Factors from 3 will add supporting documentation. By clicking below on the button labeled "I accept", you hereby acknowledge that you have read, understood and agreed to all terms and conditions set forth in this agreement. HMn1>.`Ax! Documentation of 3, 4, and 5, will lend supporting documentation.). Also, you can decide how often you want to get updates. Although guidelines applicable to certain disease categories are included, this policy is applicable to all hospice patients. 646 63 Sign up to get the latest information about your choice of CMS topics in your inbox. Although ALS usually presents in a localized anatomical area, the location of initial presentation does not correlate with survival time. An official website of the United States government. Speech ability declines to about a half-dozen intelligible words. OR Hypercapnia, as evidenced by pCO2 50 mmHg. End User License Agreement: Documentation of 3, 4, and 5, will lend supporting documentation. Surface area of involvement of hemorrhage 30% of cerebrum; Obstructive hydrocephalus in patient who declines, or is not a candidate for, ventriculoperitoneal shunt. CMS and its products and services are of every MCD page. Copyright © 2022, the American Hospital Association, Chicago, Illinois. Patients who meet the guidelines established herein are expected to have a life expectancy of six months or less if the terminal illness runs its normal course. You are leaving the CMS MCD and are being redirected to the CMS MCD Archive that contains outdated (No Longer In Effect) Local Coverage Determinations and Articles, You are leaving the CMS MCD and are being redirected to, For services performed on or after 10/01/2015, For services performed on or after 06/30/2022, AMA CPT / ADA CDT / AHA NUBC Copyright Statement, Coverage Indications, Limitations, and/or Medical Necessity, Analysis of Evidence (Rationale for Determination), LCD - Hospice Determining Terminal Status (L34538). Patient should demonstrate critically impaired breathing capacity. As each patient is unique, there are patients for whom a particular guideline does not match. 0000022017 00000 n 0000039330 00000 n endstream endobj 707 0 obj <>/Filter/FlateDecode/Index[47 599]/Length 42/Size 646/Type/XRef/W[1 1 1]>>stream Unable to ambulate without assistance. 0000005335 00000 n 0000004098 00000 n Goal: 90%. Any use not authorized herein is prohibited, including by way of illustration and not by way of limitation, making copies of CDT for resale and/or license, transferring copies of CDT to any party not bound by this agreement, creating any modified or derivative work of CDT, or making any commercial use of CDT. These should be documented in the clinical record.These changes in clinical variables apply to patients whose decline is not considered to be reversible. been made to provide accurate and complete information, CMS does not guarantee that there are no errors in the information displayed The scope of this license is determined by the AMA, the copyright holder. 0000017107 00000 n This Agreement will terminate upon notice if you violate its terms. 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. Malnutrition in Hospitalized Adults | Effective Health Care (EHC) Program May have difficulty counting from 10, both backward and sometimes forward. 0000003947 00000 n Some older versions have been archived. 1994;73:2087-2098.Hurst JW, Morris DC, Alexander RW. ), HIV DiseasePatients will be considered to be in the terminal stage of their illness (life expectancy of six months or less) if they meet the following criteria. 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. Dyspnea or fatigue due to left ventricular systolic dysfunction; asymptomatic patients who are undergoing treatment for prior symptoms of HF. 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. Intractable hyperkalemia (> 7.0) not responsive to treatment; Intractable fluid overload, not responsive to treatment. If any physical activity is undertaken, discomfort is increased.) Stage 4 (Late Confusional)Moderate cognitive decline. All rights reserved. FVC < 40% predicted (seated or supine) and 2 or more of the following symptoms and/or signs: If unable to perform the FVC test patients meet this criterion if they manifest 3 or more of the above symptoms/signs. Stage 5 (Early Dementia) Moderately severe cognitive decline. (1 and 2 should be present, factors from 3 will lend supporting documentation. H. Stroke & ComaPatients will be considered to be in the terminal stage of stroke or coma (life expectancy of six months or less) if they meet the following criteria.Stroke: Documentation of diagnostic imaging factors which support poor prognosis after stroke include: Coma (any etiology): Comatose patients with any 3 of the following on day three of coma: Documentation of the following factors will support eligibility for hospice care: Documentation of medical complications, in the context of progressive clinical decline, within the previous 12 months, which support a terminal prognosis: This policy consolidates, simplifies and supercedes the several current hospice local medical review policies on determining terminal status previously implemented by this contractor whose references are incorporated herewith. GENERAL INDICATIONS: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. B. Dementia due to Alzheimers Disease and Related DisordersPatients will be considered to be in the terminal stage of dementia (life expectancy of six months or less) if they meet the following criteria. C. Heart Disease. The AMA assumes no liability for data contained or not contained herein. Unspecified protein-calorie malnutrition. This is the American ICD-10-CM version of E46 - other international versions of ICD-10 E46 may differ. 0000037443 00000 n endstream endobj 659 0 obj <>stream patients who should be at complete rest, confined to bed or chair; any physical activity brings on discomfort and symptoms occur at rest. CMS DISCLAIMS RESPONSIBILITY FOR ANY LIABILITY ATTRIBUTABLE TO END USER USE OF THE CPT. 0000040080 00000 n J Palliative Medicine 2002; 5; 85-92. Large anterior infarcts with both cortical and subcortical involvement; Upper urinary tract infection (pyelonephritis); Medicare Contractor Medical Directors' Hospice Workgroup, B. Friedman, M. Harwood, M. Shields. Dr Reisberg has also shown that the decline typical of Alzheimer's disease is the flip side of normal skill acquisition by infants, children, and young adults: Available from ElderCare Online http://www.ec-online.net/ Barry Reisberg, MD 1984. Patients with advanced structural heart disease and marked symptoms of HF at rest despite maximal medical therapy and who require specialized interventions.