This is the American ICD-10-CM version of E46 - other international versions of ICD-10 E46 may differ. Include supporting events such as a change in the level of activities of daily living, recent hospitalizations, and the known date of death (if you are billing for a period of time prior to the billing period in which death occurred. You are leaving the CMS MCD and are being redirected to the CMS MCD Archive that contains outdated (No Longer In Effect) Local Coverage Determinations and Articles, You are leaving the CMS MCD and are being redirected to, For services performed on or after 10/01/2015, For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). )Documentation should support the level of care being provided to the patient during the time period under review, i.e. Proposed LCD document IDs begin with the letters "DL" (e.g., DL12345). RegVUA]rj N{ 8Qs. The responsibility for the content of this file/product is with CMS and no endorsement by the AMA is intended or implied. The reviewer should be able to easily identify the dates and times of changes in levels of care and the reason for the change.In addition the documentation must comply with the requirements found in accordance with CMS IOM 100-02 Chapter 9 Section 20.Disease Specific GuidelinesNote: These guidelines are to be used in conjunction with the Non-disease specific baseline guidelines described in Part II of the basic policy.Section I: Cancer Diagnoses A. Analysis of Evidence (Rationale for Determination), LCD - Hospice - Determining Terminal Status (L33393). 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. No subjective complaints of memory deficit. Progressive malnutrition, muscle wasting with dec. strength, ongoing alcoholism (>80 gm . t'h0&@,41%;j4aJEG>wJ4RA0^c Any questions pertaining to the license or use of the CPT should be addressed to the AMA. ), 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. Ogle K, Mavis B, Wang T. Hospice and primary care physicians: attitudes, knowledge, and barriers. The baseline guidelines do not independently qualify a patient for hospice coverage.Note: The word should in the disease specific guidelines means that on medical review the guideline so identified will be given great weight in making a coverage determination. Use is limited to use in Medicare, Medicaid or other programs administered by the Centers for Medicare and Medicaid Services (CMS). Progression from an earlier stage of disease to metastatic disease with either: A continued decline in spite of therapy; or. (This value may be obtained from recent [within 3 months] hospital records.). The former can be managed by artificial ventilation, and the latter by gastrostomy or other artificial feeding, unless the patient has recurrent aspiration pneumonia. (1 and 2 should be present. CMS believes that the Internet is an effective method to share LCDs that Medicare contractors develop. 1999;22(6):385-90.Lamont E, Christakis N. Prognostic disclosure to patients with cancer near the end of life. 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 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. Karnofsky Performance Status (KPS) or Palliative Performance Scale (PPS) of 40% or less; 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. 0000037955 00000 n Clin Cardiol. 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. Current Dental Terminology © 2022 American Dental Association. Such patients have no identified structural or functional abnormalities of the pericardium, myocardium, or cardiac valves and have never shown signs or symptoms of HF.Example:Systemic hypertension; coronary artery disease; diabetes mellitus; history of cardiotoxic drug therapy or alcohol abuse; personal history of rheumatic fever; family history of cardiomyopathy.Stage BPatients who have developed structural heart disease that is strongly associated with the development of HF but who have never show signs or symptoms of HF.Example:Left ventricular hypertrophy or fibrosis; left ventricular dilatation or hypocontractility; asymptomatic valvular heart disease; previous myocardial infarction.Stage CPatients who have current or prior symptoms of HF associated with underlying structural heart disease.Example:Dyspnea or fatigue due to left ventricular systolic dysfunction; asymptomatic patients who are undergoing treatment for prior symptoms of HF.Stage DPatients with advanced structural heart disease and marked symptoms of HF at rest despite maximal medical therapy and who require specialized interventions.Example: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.Karnofsky Performance Scale (KPS)The Karnofsky Performance Scale Index allows patients to be classified as to their functional impairment. A Local Coverage Determination (LCD) is a decision made by a Medicare Administrative Contractor (MAC) on whether a particular service or item is reasonable and necessary, and therefore covered by Medicare within the specific jurisdiction that the MAC oversees. Made a technical update to this LCD to remove the empty Coding Information fields. If your session expires, you will lose all items in your basket and any active searches. 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. The Tracking Sheet modal can be closed and re-opened when viewing a Proposed LCD. without the written consent of the AHA. Mild to moderate anxiety accompanies symptoms. Co-morbidities. Severity of malnutrition is based on phenotypic criteria only and requires one phenotypic criterion that meets the threshold of . 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. The patient is not seeking dialysis or renal transplant, or is discontinuing dialysis. Q&A: Documentation and ICD-10-CM coding for severe malnutrition For principle diagnoses in which severe protein-calorie malnutrition could be listed as a MCC, there must be documentation demonstrating additional Q&A: Documenting and coding severe malnutrition | ACDIS guidelines described in Part I. Alternatively, the baseline non-disease specific guidelines described in Part II plus the applicable disease specific guidelines listed in Part III will establish the necessary expectancy. of every MCD page. ), Progression of end stage pulmonary disease, as evidenced by increasing visits to the emergency department or hospitalizations for pulmonary infections and/or respiratory failure or increasing physician home visits prior to initial certification. All Rights Reserved. AHA copyrighted materials including the UB‐04 codes and 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. LCD - Hospice Determining Terminal Status (L34538) Hospice Appropriate Diagnoses - StatPearls - NCBI Bookshelf Patient should demonstrate critically impaired breathing capacity. 0000017107 00000 n ): G. Renal DiseasePatients will be considered to be in the terminal stage of renal disease (life expectancy of six months or less) if they meet the following criteria.Acute renal failure: (1 and either 2 or 3 should be present. Progressive loss of abilities to walk, sit up, smile, and hold head up. 0000037087 00000 n At this time 21st Century Cures Act will apply to new and revised LCDs that restrict coverage which requires comment and notice. This page displays your requested Local Coverage Determination (LCD). R8Revision Effective: 05/06/2021Revision Explanation: Corrected typo in the associated information section under acute renal failure. The responsibility for the content of this file/product is with CMS and no endorsement by the AMA is intended or implied. 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. Incontinent of urine, requires assistance toileting and feeding. Disabled; requires special care and assistance. 0000040550 00000 n Another option is to use the Download button at the top right of the document view pages (for certain document types). (1 and 2 should be present. West J Med. The criteria refer to patients with various forms of advanced pulmonary disease who eventually follow a final common pathway for end stage pulmonary disease. "JavaScript" disabled. The New York Heart Association (NYHA) Functional Classification provides a simple way of classifying heart disease (originally cardiac failure). Speech ability declines to about a half-dozen intelligible words. 0000012920 00000 n Neither the United States Government nor its employees represent that use of 2003;20: 41-51.Ogle K, Mavis B, Wang T. Physicians and hospice care: attitudes, knowledge and referrals. The score can help determine which patients can be managed in the home and which should be admitted to a hospice unit. If you are experiencing any technical issues related to the search, selecting the 'OK' button to reset the search data should resolve your issues. History of increasing ER visits, hospitalizations, or physician visits related to the hospice primary diagnosis prior to election of the hospice benefit. Current Dental Terminology © 2022 American Dental Association. Frequently continue to be able to distinguish familiar from unfamiliar persons in their environment. If any physical activity is undertaken, discomfort is increased.) HUjI}iuU!v` "Y]I!T 3:NU^#={6: K]Sdl*B!XA-m2{gcm8n W)' fvtkW~e,y&2%!98kzb . The CMS.gov Web site currently does not fully support browsers with On the other hand, patients in the terminal stage of their illness who originally qualify for the Medicare hospice benefit but stabilize or improve while receiving hospice care, yet have a reasonable expectation of continued decline for a life expectancy of less than six months, remain eligible for hospice care.IndicationsA patient will be considered to have a life expectancy of six months or less if he/she meets the non-disease specific "Decline in clinical status" guidelines described in Part I. Alternatively, the baseline non-disease specific guidelines described in Part II plus the applicable disease specific guidelines listed in Part III will establish the necessary expectancy.Part I. National Government Services is not responsible for the continuing viability of Web site addresses listed below. 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.