protein calorie malnutrition hospice criteria

Dyspnea with increasing respiratory rate; Nausea/vomiting poorly responsive to treatment; Pain requiring increasing doses of major analgesics more than briefly. malnutrition (263.0: Malnutrition of a Moderate Degree) and severe malnutrition (262: Other Severe Protein Calorie Malnutrition). The AMA disclaims responsibility for any consequences or liability attributable to or related to any use, non-use, or interpretation of information contained or not contained in this file/product. sensitive to and specic for protein-calorie malnutrition.4 Serum hepatic protein levels help the clinician to identify the sickest of patientsthose who may be more likely to develop malnutrition.1 It is imperative that the registered dietitian nutritionist in-terprets hepatic protein levels in the context of the patient's overall health If you are experiencing any technical issues related to the search, selecting the 'OK' button to reset the search data should resolve your issues. Sign up to get the latest information about your choice of CMS topics in your inbox. Documentation of 3, 4, and 5, will lend supporting documentation. May have difficulty counting from 10, both backward and sometimes forward. (Documentation of serial decrease of FEV1>40 ml/year is objective evidence for disease progression, but is not necessary to obtain. Noticeable deficits in demanding job situations. LCDs outline how the contractor will review claims to ensure that the services provided meet Medicare coverage requirements. and/or making any commercial use of UB‐04 Manual or any portion thereof, including the codes and/or descriptions, is only There is no regulation precluding patients on dialysis from electing Hospice care. 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. 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. presented in the material do not necessarily represent the views of the AHA. These are quite variable and include: Stage 7 (Late Dementia) Very severe cognitive decline. 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. Pyelonephritis or other upper urinary tract infection; Inability to maintain sufficient fluid and calorie intake with 10% weight loss during the previous six months or serum albumin <2.5 gm/dl. Experiences urinary and fecal incontinence. If an entity wishes to utilize any AHA materials, please contact the AHA at 312‐893‐6816. E. Lamont, N. Christakis. patients who should be at complete rest, confined to bed or chair; any physical activity brings on discomfort and symptoms occur at rest. 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. -*B Y81Ll8#\RRJvbbO:6c%^i4Ueuilos~8_i/qXlnv6L_KerIkEOL;v:5mMGzjqnfS)8UVy+YWyy~''vaOWpI.B'{0}|}|}|I,%%%%%%%%%%%%_^Az Should the foregoing terms and conditions be acceptable to you, please indicate your agreement and acceptance by clicking below on the button labeled "I Accept". Protein-calorie malnutrition (PCM) occurs when a child doesn't eat enough proteins and calories to meet nutritional needs. Recertification for hospice care requires the same clinical standards be met as for initial certification, but they need not be reiterated. RegVUA]rj N{ 8Qs. Cares for self; unable to carry on normal activity or to do active work. 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. 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. Patient is unable during interview to recall a major relevant aspect of their current lives, e.g., an address or telephone number of manyyears, the names of close family members (such as grandchildren), the name of the high school or college from which they graduated. 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. Requires assistance dressing, bathing, and toileting. Progressive decline in Functional Assessment Staging (FAST) for dementia (from 7A on the FAST). They would use ICD-10-CM code E42 to report severe protein-calorie malnutrition with signs of both kwashiorkor and marasmus. An educated person may have difficulty counting back from 40 by 4s or from 20 by 2s. Other clinical variables not on this list may support a six-month or less life expectancy. Documentation of 3, 4, and 5, will lend supporting documentation.). Thus a patient with metastatic small cell CA may be demonstrated to be hospice eligible with less documentation than a chronic lung disease patient. Revision Explanation: Annual review no changes made. Use is limited to use in Medicare, Medicaid or other programs administered by the Centers for Medicare and Medicaid Services (CMS). 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. Patient should demonstrate both rapid progression of ALS and life-threatening complications. All rights reserved. forgetting where one has placed familiar objects; patient may have gotten lost when traveling to an unfamiliar location; co-workers become aware of patient's relatively low performance; word and name finding deficit becomes evident to intimates; patient may read a passage of a book and retain relatively little material; patient may demonstrate decreased facility in remembering names upon introduction to new people; patient may have lost or misplaced an object of value; concentration deficit may be evident on clinical testing. Nausea/vomiting poorly responsive to treatment. A patient will be considered to have a life expectancy of six months or less if he/she meets the non-disease specific. Non-disease specific baseline guidelines (both of these should be met), See appendix for disease specific guidelines to be used with these (Part II) baseline guidelines. Coma Primary Criteria Patient with any 3 of the following on day three of coma: 1. Malnutrition, Obesity and BMI : Medical Coding Guidelines SPECIFIC INDICATIONS:A 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 the appendix will establish the necessary expectancy. Similarly, . (1 and 2 should be present, factors from 3 will lend supporting documentation. Surface area of involvement of hemorrhage greater than or equal to 30% of cerebrum; Midline shift greater than or equal to 1.5 cm. ): Patients awaiting liver transplant who otherwise fit the above criteria may be certified for the Medicare hospice benefit, but if a donor organ is procured, the patient should be discharged from hospice.F. Non-disease specific baseline guidelines (both A and B should be met), Part III. Recurrent or intractable infections such as pneumonia, sepsis or upper urinary tract. Neither the United States Government nor its employees represent that use of By the time patients become end-stage, muscle denervation has become widespread, affecting all areas of the body, and initial predominance patterns do not persist. Although not the primary hospice diagnosis, the presence of disease such as the following, the severity of which is likely to contribute to a life expectancy of six months or less, should be considered in determining hospice eligibility. The views and/or positions All Rights Reserved (or such other date of publication of CPT).

Lady Justice Statue London, Articles P