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 for certain diagnosis codes. It appears CMS is explicitly stating that it does not consider debility, failure to thrive, dementia and other similar diagnosisc odes to be appropriate as a principal diagnosis code for hospice claims. NAHC is recommending that that all hospices review each case where these diagnosis codes are listed as the principle diagnosis. Agencies should also be reporting all related co-morbidity diagnosis codes on their claims."
Has anyone heard anything further? This is concerning since there are patients who truly only qualify under one of these 3 diagnoses.
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.
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.
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.
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
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?
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.
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.
SuesquatchRN, BSN, RN
10,263 Posts
Why does someone dying of old age need hospice? Dying does not always require interventions.