Medicare Diagnosis Changes - page 4

by Stella1688

8,499 Views | 36 Comments

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 returning claims to Hospice providers... Read More


  1. 0
    For sure. Depending on the admission nurse, sometimes our company admits PPS 70 dementia patients. It never makes sense to me.
  2. 0
    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%
  3. 1
    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"
    Stella1688 likes this.
  4. 0
    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.
  5. 0
    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.
  6. 0
    I would be leery too! That is still quite functional and inappropriate for a dementia primary dx
  7. 2
    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
    PamRNinTX and SuesquatchRN like this.


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