Medicare Diagnosis Changes

[SuesquatchRN, BSN, RN]

But there are still 95 year olds out there with no real co-morbidities who are just dying from old age...and at times it is impossible to find them eligible for hospice.

Why does someone dying of old age need hospice? Dying does not always require interventions.

[curiousauntie]

Symptom management at end of life? Emotional support, education and assistance to the family members who are caring for the patient? Just because there is no real clear cut "diagnosis" does not mean the patient will just fall asleep and never wake up. They and the family deserve the interventions hospice can provide.

[SuesquatchRN, BSN, RN]

Again, we disagree that simple old age requires skilled intervention.

[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.

[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

[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?

[Kabin]

For sure. Depending on the admission nurse, sometimes our company admits PPS 70 dementia patients. It never makes sense to me.

[NC29mom, ASN, LPN, RN]

For sure. Depending on the admission nurse' date=' sometimes our company admits PPS 70 dementia patients. It never makes sense to me.[/quote']

I'd be leary signing my name to an admission of a dementia pt with a pps of 70%

[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"

[SuesquatchRN, BSN, RN]

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.

[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.

[Stella1688]

I would be leery too! That is still quite functional and inappropriate for a dementia primary dx