hospice diagnosis help - page 2
hi, I am a home healthcare nurse whose agency is 'creeping' into hospice. there are no hospice services in my area.........kinda rural and such.............anyways, I approached the hospice... Read More
Jan 14, '04When I worked in hospice, Medicare refused to reimburse for all of our pts who were diagnosed with "Failure to Thrive" or "Multi-system Failure". Medicare said these dx were not approved terminal dx, and our company lost a lot of money. Medicare does reimburse for dx of "Debility- unspecified".
This dx is often used in leau of TMBD (too many birthdays). lol.Last edit by Hellllllo Nurse on Jan 18, '04
Jan 15, '04Nice to have those links! Thanks. We often use FTT in our program... once you get used to the guidelines, it makes eligibility pretty clear cut. We've never had Medicare refuse payment on these patients.
Jan 15, '04We use FTT and just work off the guidelines in the workbook NHO has for non-malignancy dx.
Jan 18, '04We also use debility unspecified, but use it carefully because then Hospice has to pay for ALL of the drugs they take. This can be very costly. Just a thought.
Jan 18, '04I left hospice nursing in '97. My company was denied payment for pts w/ FTT and multi-system failure as their terminal dx for pts treated in the mid-1990s. Things may have changed since then.
Dec 20, '09A physician order of course is necessary.
Here are a few bits of Hospice Criteria for Failure to Thrive.
*BMI < 22kg/M
*Declining enteral/paraenteral nutritional support or notn responding to such support.
*Karnofsky score of 12 or less.
*ADL score of 12 or less.
*Descriptive score of 19 or less.
*At time of recert. recumbent measurements (anthropometry) mid-arm circumference in/cm may be substituted for BMI with documentation as to why BMI could not be measured.
*Other co-morbid conditions:
Frequent opportunistic infections
Weight loss of>10% over preceding months
I hope this helps. I have been a hospice nurse for almost 10 years. Its very difficult to keep up with everyone and all of the criteria as things change in the patients condition.
Good luck and God Bless~ AmshockleyLast edit by amshockley on Dec 20, '09 : Reason: addition
Dec 20, '09Debility is a bugger of a diagnosis----I believe AFTT is also a diagnosis where company also has to cover all of the medications, and with the very elderly folks, they are on a billion medications (or so it seems when you look at the cost).
We work hard within the first cert period to find something more concrete-CHF, etc to aleviate the high cost of medications.