protein calorie malnutrition hospice criteria

Any questions pertaining to the license or use of the CPT should be addressed to the AMA. Recertification for hospice care requires the same clinical standards be met as for initial certification, but they need not be reiterated. 0000039400 00000 n 0000029167 00000 n 2002;5:85-92.O'Toole DM. 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. copied without the express written consent of the AHA. Accessed 01/16/2008.Schag CC, Heinrich RL, Ganz, PA. Karnofsky performance status revisited: Reliability, validity, and guidelines. But specific entries can also call for an answer, such as an opinion by one team member or recovery of ADLS when they were part of the basis for the initial declaration of eligibility. Some patients may not meet these guidelines, yet still have a life expectancy of 6 months or less. E46 is a billable/specific ICD-10-CM code that can be used to indicate a diagnosis for reimbursement purposes. The Social Security Act, Sections 1869(f)(2)(B) and 1862(l)(5)(D) define LCDs and provide information on the process. Please visit the. 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. HUjI}iuU!v` "Y]I!T 3:NU^#={6: K]Sdl*B!XA-m2{gcm8n W)' fvtkW~e,y&2%!98kzb . ]6o?7#qij]e]#mvb:~=y1\N(QhnX- }%h=#8At#ZRUpJK$\v&$&Np\KOI&'=%Oxu}j.bJBmv;]wy'.p|Wst]M3 \;y^zLGazW@ZzLgZ\$f29o"T=c(%/&Kp:,j{L Fu G Secondary Criteria Notes . The views and/or positions ge"^WOgr |___W+ tpIht=hozGC8 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. descriptions may not be removed, copied, or utilized within any software, product, service, solution or derivative work 0000040550 00000 n 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. 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. In addition, an administrative law judge may not review an NCD. The New York Heart Association (NYHA) Functional Classification provides a simple way of classifying heart disease (originally cardiac failure). CMS and its products and services are ), 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. 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 < 25 cells/mcl or persistent (2 or more assays at least one month apart) viral load >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 less than or equal to 50%. 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. You can use the Contents side panel to help navigate the various sections. 708 0 obj <>stream Please note that if you choose to continue without enabling "JavaScript" certain functionalities on this website may not be available. copied without the express written consent of the AHA. Unable to ambulate without assistance. The score can help determine which patients can be managed in the home and which should be admitted to a hospice unit. The page could not be loaded. Copyright © 2022, the American Hospital Association, Chicago, Illinois. Nutritional supplementation is one of the most important interventions in patients with failure to thrive. All rights reserved. Please review and accept the agreements in order to view Medicare Coverage documents, which may include licensed information and codes. Alzheimer's disease and other progressive dementias are life-altering and eventually fatal conditions for which curative therapy is not available. You agree to take all necessary steps to insure that your employees and agents abide by the terms of this agreement. Incontinent of urine, requires assistance toileting and feeding. 0000006339 00000 n (1 and either 2, 3 or 4 should be present. The Tracking Sheet modal can be closed and re-opened when viewing a Proposed LCD. Co-morbidities. 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. This Agreement will terminate upon notice if you violate its terms. Revision Explanation: Annual review, no changes made. You agree to take all necessary steps to ensure that your employees and agents abide by the terms of this agreement. CPT codes, descriptions and other data only are copyright 2022 American Medical Association. 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. Although guidelines applicable to certain disease categories are included, this LCD is applicable to all hospice patients. This is the American ICD-10-CM version of E46 - other international versions of ICD-10 E46 may differ. rVjh)aV 5%TO)i='@]Rx\EM~{m.3:t.UPu]*;bSj7U 0%q3- RJT40(?9O1UsFS3*CR|lf[`s40Q\r*u22,!5jc-+z ]o s 0000008839 00000 n 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". CEA, PSA); Progressively decreasing or increasing serum sodium or increasing serum potassium. Hepatic encephalopathy, refractory to treatment, or patient non-compliant; Recurrent variceal bleeding, despite intensive therapy. They invariably know their own names and generally know their spouse's and children's names. 0000009983 00000 n (1 and 2 should be present. It is intended to be used to identify any Medicare beneficiary whose current clinical status and anticipated progression of disease is more likely than not to result in a life expectancy of six months or less.Clinical variables with general applicability without regard to diagnosis, as well as clinical variables applicable to a limited number of specific diagnoses, are provided. Percentage of patients receiving PN in the ICU who receive 80% of estimated energy requirements or 20 kcals/kg/day and a minimum of 1.2 g protein/kg/day. It is rare occurrence in the U.S. E41 is used to report nutritional marasmus, a form of malnutrition characterized by consumption of . The patient is not seeking dialysis or renal transplant, or is discontinuing dialysis. Healthcare providers retain responsibility to submit complete and accurate. These should be documented in the clinical record.These changes in clinical variables apply to patients whose decline is not considered to be reversible. Protein Calorie Malnutrition Severe Protein Calorie Malnutrition Moderate Protein Calorie Malnutrition Severe Protein Calorie Malnutrition Energy Intake <75% of EEE >7 days 50 % of EEE >5 days <75% of EEE 1 month <75% of EEE 1 month <75% of EEE 3 months 50% of EEE 1 month Weight Loss Similarly, . for diabetics); or < 15cc/min (< 20cc/min for diabetics) with comorbidity of congestive heart failure. The AMA does not directly or indirectly practice medicine or dispense medical services. No portion of the American Hospital Association (AHA) copyrighted materials contained within this publication may be Applicable FARS/HHSARS apply. Instructions for enabling "JavaScript" can be found here. P rint Checklist: Documenting malnutrition (E41 and E43) This checklist is intended to provide healthcare providers with a reference for use when responding to medical documentation requests for services rendered and hospital admissions to treat malnutrition. endstream endobj 657 0 obj <> endobj 658 0 obj <>stream Progressive inanition is documented by several measures such as 10% body weight loss, decreased albumin, and dysphagia leading to aspiration, among others. You shall not remove, alter, or obscure any ADA copyright notices or other proprietary rights notices included in the materials. Although coding guidelines state that only one of these criteria needs to be met . The AMA assumes no liability for data contained or not contained herein. Symptoms of heart failure or of the anginal syndrome may be present even at rest. -*B Y81Ll8#\RRJvbbO:6c%^i4Ueuilos~8_i/qXlnv6L_KerIkEOL;v:5mMGzjqnfS)8UVy+YWyy~''vaOWpI.B'{0}|}|}|I,%%%%%%%%%%%%_^Az resale and/or to be used in any product or publication; creating any modified or derivative work of the UB‐04 Manual and/or codes and descriptions; Karnofsky Performance Status (KPS) or Palliative Performance Scale (PPS) of < 40% . You can use your browser's Print function (Ctrl-P on a PC or Command-P on a Mac) to view a print preview and then select PDF as the output. Federal government websites often end in .gov or .mil. Reproduced with permission. Physiologic impairment of functional status as demonstrated by: Karnofsky Performance Status (KPS) or Palliative Performance Score (PPS) < 70%. hbbRc`b``3 1x4>.0 British Medical Journal. If you are experiencing any technical issues related to the search, selecting the 'OK' button to reset the search data should resolve your issues. Please enable "JavaScript" and revisit this page or proceed with browsing CMS.gov with Patients with dementia or Alzheimer's are eligible for hospice care when they show all of the following characteristics: 1. Therefore, multiple clinical parameters are required to judge the progression of ALS. The population for key question 3 will only include patients with a diagnosis of protein-energy malnutrition. 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. Manifestations in more than one of the following areas: Objective evidence of memory deficit obtained only with an intensive interview. Neurologic disease (CVA, ALS, MS, Parkinsons), Refractory severe autoimmune disease (e.g. Factors from 4 will lend supporting documentation. 0000003355 00000 n The criteria refer to patients with various forms of advanced pulmonary disease who eventually follow a final common pathway for end stage pulmonary disease. This revision is not a restriction to the coverage determination; and, therefore not all the fields included on the LCD are applicable as noted in this policy. 0000005335 00000 n Part III. Thus a patient with metastatic small cell CA may be demonstrated to be hospice eligible with less documentation than a chronic lung disease patient. 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. Very sick; hospital admission necessary; active supportive treatment necessary. The scope of this license is determined by the AMA, the copyright holder. Instructions for enabling "JavaScript" can be found here. http://www.ed-online.net\. 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. Pulmonary Disease. 0000007316 00000 n E. Lamont, N. Christakis. Part II. Patients with dementia should show all the following characteristics: Patients should have had one of the following within the past 12 months: Note: This section is specific for Alzheimers Disease and related disorders, and is not appropriate for other types of dementia, such as multi-infarct dementia. of every MCD page. Severe chronic lung disease as documented by both a and b: Disabling dyspnea at rest, poorly or unresponsive to bronchodilators, resulting in decreased functional capacity, e.g., bed to chair existence, fatigue, and cough: (Documentation of Forced Expiratory Volume in One Second (FEV1), after bronchodilator, less than 30% of predicted is objective evidence for disabling dyspnea, but is not necessary to obtain. The AMA does not directly or indirectly practice medicine or dispense medical services. Unable to dress without assistance. K. Ogle, B. Mavis, T. Wang. 1999;22(6):385-90.Lamont E, Christakis N. Prognostic disclosure to patients with cancer near the end of life. Creatinine clearance <10 cc/min (< 15 cc/min for diabetics); or < 15cc/min (< 20cc/min for diabetics) with comorbidity of congestive heart failure. CMS believes that the Internet is an effective method to share LCDs that Medicare contractors develop. Circulation. R8Revision Effective: 05/06/2021Revision Explanation: Corrected typo in the associated information section under acute renal failure. Laboratory tests in protein-calorie malnutrition Lancet. Stage 3 (Early Confusional)Mild cognitive decline. 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. ), 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. Federal government websites often end in .gov or .mil. In such cases, it is important for providers to meticulously document the factors which specify the individuals terminal prognosis.There are also patients who match a guideline at the start of hospice care, and who continue to do so for a prolonged period, e.g., greater than six months. Progression from an earlier stage of disease to metastatic disease with either:1. a continued decline in spite of therapy2. Some patients may not meet these guidelines, yet still have a life expectancy of six months or less. patients with slight, mild limitation of activity; they are comfortable with rest or with mild exertion. Significant congestive heart failure may be documented by an ejection fraction of 20%, but is not required if not already available. 0000017107 00000 n - Social Security Act, Sections 1102, 1812 (a)(4) and (d); 1813 (a) (4); 1814 (a)(7) and (I); 1862 (a)(1), (6), and (9); 1861 (dd), 1871- 42 CFR Part 418- CMS Publication 100-02, Medicare Benefit Policy, Chapter 9.- CMS Publication 100-04, Medicare Claims Processing, Chapter 30. 0000012375 00000 n The AMA is a third party beneficiary to this Agreement. It does not mean, however, that meeting the guideline is obligatory. CMS and its products and services are not endorsed by the AHA or any of its affiliates. Symptoms of heart failure or of the anginal syndrome may be present even at rest. Recommendation: Target blood glucose range of 140 - 180 mg\dL for the general ICU population. 1991;155:384-387.Reisberg B. ElderCare online. Instructions for enabling "JavaScript" can be found here. 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 American Hospital Association (the "AHA") has not reviewed, and is not responsible for, the completeness or Patient declines further disease directed therapy. Although guidelines applicable to certain disease categories are included, this LCD is applicable to all hospice patients. Patients who have current or prior symptoms of HF associated with underlying structural heart disease. 0000003910 00000 n Progression of disease differs markedly from patient to patient. J Gerontol. 0000017875 00000 n 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. 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. The amendment clarified that the certification is based on a clinical judgment regarding the usual course of a terminal illness, and recognizes the fact that making medical prognostications of life expectancy is not always exact.However, the amendment regarding the physician's clinical judgment does not negate the fact that there must be a basis for a certification.