Hospice Webinar Series 2021 Presenter: Sharon M Litwin, RN, BSHS, MHA, HCS-D Hospice Coding Refresher February 5, 2021 Objectives Coding Conventions & Guidelines Hospice Coding Primary Diagnosis/Terminal Illness Hospice Coding Secondary/Comorbid Diagnosis Disease Specific Criteria for Hospice 1 2 0 As of January 1, 2021, participating Medicare Advantage Organizations can include the Medicare hospice benefit in their Part A benefits package. 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For a patient to be eligible for hospice, consider the following guidelines: The illness is terminal (a prognosis of 6 months) and the patient and/or family has elected palliative care. 1809 0 obj <>/Filter/FlateDecode/ID[<2D9644EDBFBC9A43B5CFB6E8E4772936>]/Index[1779 52]/Info 1778 0 R/Length 133/Prev 308867/Root 1780 0 R/Size 1831/Type/XRef/W[1 3 1]>>stream CGS has developed a hospice LCD, ID# L34538 titled Hospice Determining Terminal Status, using the National Hospice and Palliative Care Organization's (NHPCO) guidelines. These very short stays in hospice are considered too short a period for patients to fully benefit from the unique person-centered, interdisciplinary care provided by hospice. Though cancer still dominates the rankings, new advancements in the treatment of cancer have led to gradual declines in the number of hospice admissions and deaths from this . For example, list the medical condition that led to the debility (malignant neoplasm, end-stage renal disease, COPD). There should be a frequent re-evaluation of the patients status as appropriate for continued hospice care through the lens of physical, mental, social, and spiritual needs. Here are the top 20 most frequently hospice claims-reported diagnoses for 2017. Ph: 571-412-3973, 1731 King Street Should have had at least one of the following in the 12 months preceding hospice referral: Poor prognosis supported by presence of comorbid conditions like COPD, CHF, CAD, DM, Parkinsons, stroke, renal failure, liver disease or AIDS, Not seeking dialysis or renal transplant OR discontinuing dialysis. on Top 20 Principal Hospice Diagnoses for 2017, Top 20 Principal Hospice Diagnoses for 2017, Tech & Innovation in Healthcare eNewsletter, IDR Payment Determinations Resume Under No Surprises Act, MRI for Patients with Cardiac Device, Covered, Add These OIG Watch Items to Your Audit List, Get Paid for COVID-19 Testing/Treatment of Uninsured, President Signs Bill to Fix the SGR for Six Months, J44.9 Chronic obstructive pulmonary disease, G31.1 Senile degeneration of brain, not elsewhere classified, C34.90 Malignant neoplasm of unspecified part of unspecified bronchus or lung, G30.1 Alzheimers disease with late onset, I25.10 Atherosclerotic heart disease of native coronary art without angina pectoris, J44.1 Chronic obstructive pulmonary disease with (acute) exacerbation, C18.9 Malignant neoplasm of colon, unspecified, C25.9 Malignant neoplasm of pancreas, unspecified, I11.0 Hypertensive heart disease with heart failure, I67.9 Cerebrovascular disease, unspecified, I13.0 Hypertensive heart and chronic kidney disease with heart failure and stage 1 through stage 4 chronic kidney disease, or unspecified chronic kidney disease. Patients have to meet all of Medicare's hospice eligibility criteria, which include: 1. C. Comorbidities: when the condition is not the designated primary hospice diagnosis, the presence of significant disease thought to contribute to a prognosis of 6 months or less survival should be considered, such as[8][9][10][11]: This book is distributed under the terms of the Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International (CC BY-NC-ND 4.0) Download the new report, NHPCO Facts and Figures (PDF). ICD-10-CM Diagnosis Code O32.4. Generally, Medicare pays hospice agencies a daily rate for each day a patient is enrolled in the hospice benefit. The coinsurance amount is 5% of the cost of the drug or biological to the hospice, determined by the drug copayment schedule set by the hospice. The following clinical signs often support hospice eligibility in combination with another primary diagnosis. Therefore, diagnoses made in the past that have no bearing on the patients current status or ongoing prognosis (history codes) should be removed per coding guidelines. endstream endobj 434 0 obj <>/Metadata 20 0 R/Names 456 0 R/Outlines 36 0 R/Pages 429 0 R/StructTreeRoot 37 0 R/Type/Catalog/ViewerPreferences 457 0 R>> endobj 435 0 obj <>/MediaBox[0 0 612 792]/Parent 429 0 R/Resources<>/Font<>/ProcSet[/PDF/Text/ImageC]/XObject<>>>/Rotate 0/StructParents 13/Tabs/S/Type/Page>> endobj 436 0 obj <>stream Variations Among Physicians in Hospice Referrals of Patients With Advanced Cancer. The Median Length of Service (MLOS) was 18 days, which has changed little in the last fifteen years. Hospice claims can support up totwenty-five diagnoses, and if there are some diagnoses without designated codes or for whatever reason cannot be placed in the diagnoses section, those conditions can receive coverage in the narrative part of the plan of care in the documentation. B95.0. Inappropriate Primary Diagnosis Codes ICD-10-CM list updated 8/14/2020 Policy Verbiage Update, added the word "Commercial" to header section 3/1/2020 Policy Version Change: In fact, static diagnoses over time might falsely convey stability of a patients condition and theoretical reevaluation of the patient as being an appropriate hospice candidate. lock Hospice organizations can assist in determining eligibility for patients suffering from terminal illnesses. Nearly 43 percent (42.7) of Hispanic Medicare beneficiary decedents and almost 41 percent (40.8) of Black Medicare beneficiary decedents enrolled in hospice in 2019. Accessed June 23 . There must be a complete evaluation of the totality of their conditions for each patient, including hospice-appropriate diagnoses and treatment plans. The level of care that will be provided by the hospice upon discharge is essential to determining the proper code to use. Often, these physicians who manage and monitor care during the length of service have additional training beyond residency by completing a dedicated fellowship, thereby earning board certification in the medical subspecialty of hospice and palliative medicine. The rates are established using the methodology described in section 1814 (i) (1) (C) of the Act and in accordance with section 1814 (i) (6) (D) of the Act. Hospice of Mercy offers tips on when to refer patients to hospice. Hospice care changes the focus to comfort care (palliative care) for pain relief and symptom management instead of care to cure the patients illness. Often, these physicians who manage and monitor care during the length of service have additional train means youve safely connected to the .gov website. Information for Hospice Providers . is it okay to take melatonin after covid vaccine. Source: FY 2017 hospice claims data from the CCW, accessed and merged with ICD-10 codes on January 10, 2018. Typically, there is an interprofessional team focus led by a physician medical director. As with each new set of guidelines, revised standards, or updated ICD codes, there are further changes to the interpretation and guidance of hospice diagnoses and regulations. Routine Home Care accounted for 98.3 percent of days of care provided. Enrollment into hospice service is not as simple as a patients primary physician making a prognosis of fewer than six months to live. This . All diagnoses Brief Issue Description. For example, one of the codes they reclassified as "acceptable" Urinary tract infection, site not specified (N39.0) is often the primary diagnosis code. Wang X, Knight LS, Evans A, Wang J, Smith TJ. Hospice and palliative medicine: new subspecialty, new opportunities. The specified codes are identified with an asterisk. The patient does not owe any coinsurance when they got it during general inpatient care or respite care. In addition, this rule proposes to rebase the labor shares of the hospice payment Hospice Eligibility Criteria Patient has a terminal illness with a life expectancy of 6 months or less CANCER Pt meets ALL of the following: 1. Renee has more than 30 years' experience in journalistic reporting, print production, graphic design, and content management. 2017 Apr;15(2):168-175. Effective October 1, 2014, these diagnoses are no longer permitted as principal diagnosis codes on hospice claims. http://creativecommons.org/licenses/by-nc-nd/4.0/ CMS establishes payment rates for each of the categories of hospice care described in 418.302 (b). endstream endobj startxref Include a number of symptoms, including nausea and vomiting, dyspnea, persisting cough, fatigue, decreased cognition, diarrhea, and progressive pain, Include a number of clinical signs, including hypotension, edema, ascites, progressive weakness, new altered mental status, among others, Include a number of laboratory findings, including worsening pCO2/pO2/SaO2 values, worsening liver function tests, worsening tumor markers, and volatile sodium and potassium, among others, Chronic obstructive pulmonary disease (COPD), Neurologic disease (cerebrovascular accident, Parkinson disease, multiple sclerosis, amyotrophic lateral sclerosis), Refractory severe autoimmune disease (e.g., lupus or rheumatoid arthritis). This list is not all inclusive. Common diagnoses that are unacceptable primary diagnoses for Home Health under PDGM: . hospice benefit, but if a donor organ is procured, the patient must be discharged from hospice. Some treatments for chronic conditions may cause more harm than good during the terminal stages of life. Patients with Medicare Part A can get hospice care benefits if they meet the following criteria: After certification, the patient may elect the hospice benefit for: All hospice care and services offered to patients and their families must follow an individualized written plan of care (POC) that meets the patients needs. Alternatively, therapies might fall into the non-palliative category or be futile given the stage of the disease. Indiana Health Coverage Programs Hospice Services Codes Published: September 28, 2021 6 Table 2 - ICD-10 Diagnosis Codes for Amyotrophic Lateral Sclerosis (ALS) Reviewed/Updated: April 1, 2021 Diagnosis Code Description

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