Medicare Diagnosis Changes - page 3

Hi All, I got the following message from NAHC regarding proposed CMS changes: NAHC is reporting that in the CMS Open Door Forum held on May 8, CMS indicated thatin the future they will be... Read More

  1. by   SuesquatchRN
    Again, we disagree that simple old age requires skilled intervention.
  2. by   PamRNinTX
    First of all, CMS is not denying Dementia as a terminal diagnosis - if coded properly. We use Senile Degenerate Brain for our Dementia DX. Secondly, I disagree with CMS's clarification that AFTT and Debility are "ill defined" as a terminal DX and therefore should not be submitted on claims as the primary DX. Our MAC, Palmetto, has been fighting this with CMS so we'll see... the definition of AFTT includes a disease process by which death is expected within 6 months. We had a patient who we were admitting, who was inpatient, dying, and had NO co-morbidities other than Debility. We used Debility and are prepared to appeal if the claim is denied.

    Another interesting clarification by CMS, is that AFTT and Debility can be listed as secondary conditions - so, if your patient does not quite meet the criteria for Dementia, but has AFTT, then you probably have a patient who is hospice appropriate because of the AFTT as secondary.

    Lastly, keep in mind that Hospice is a benefit. Recently published studies have proven that hospice patients reduce Medicare and Medicaid costs due to significantly fewer hospital stays or ER visits.
  3. by   Stella1688
    Just curious, who decided on coding "senile degenerative brain" for dementia? Is there any documentation that this is a better coding choice than just regular dementia, or was it just a company decision? I appreciate your input
  4. by   Stella1688
    I'm more curious on everyone's views on dementia as a terminal diagnosis. I think most of us agree that debility is way overused. What about the patient with advanced dementia that can no longer swallow and continues to aspirate, has had a >10% weight loss, needs pain and/or resp distress med management and FAST scale worse than 7A? Are you all still admitting these patients under a primary of dementia if they have no other qualifying conditions?
  5. by   Kabin
    For sure. Depending on the admission nurse, sometimes our company admits PPS 70 dementia patients. It never makes sense to me.
  6. by   NC29mom
    Quote from Kabin
    For sure. Depending on the admission nurse, sometimes our company admits PPS 70 dementia patients. It never makes sense to me.
    I'd be leary signing my name to an admission of a dementia pt with a pps of 70%
  7. by   PamRNinTX
    In Answer to Stella1688. Our MAC is Palmetto and the current LCD includes:

    "ICD-9 Codes that Support Medical Necessity
    290.3 SENILE DEMENTIA WITH DELIRIUM
    294.21 DEMENTIA, UNSPECIFIED, WITH BEHAVIORAL DISTURBANCE
    331.0 ALZHEIMER'S DISEASE
    331.11 PICK'S DISEASE
    331.2 SENILE DEGENERATION OF BRAIN
    331.6 CORTICOBASAL DEGENERATION"
  8. by   SuesquatchRN
    We still admist for straight dementia. I think many folks with ES dementia are not hospice appropriate but they meet CMS criteria. What is really needed is more education, in nursing and medical school, about EOL issues and their management. Many things should be easily managed with hospice-specific intervention.
  9. by   Stella1688
    Thanks PamRNinTX, I have often used 294.21 or 331.0 if their chart specifically says Alzheimers. It seems like Senile Degeneration of Brain is a safe bet though.
  10. by   Stella1688
    I would be leery too! That is still quite functional and inappropriate for a dementia primary dx
  11. by   Stella1688
    Hi SuesquatchRN...just to put this out there, there is a bill in congress requesting increased funding for hospice and palliative education to be mandatory in all accredited medical and nursing schools. It has a poor chance of passing but sometimes it helps to write your state rep in support of the bill. Here's the link of you are interested Text of H.R. 1339: Palliative Care and Hospice Education and Training Act (Introduced version) - GovTrack.us

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