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Hospice documentation guide
ALS (Amyotrophic Lateral Sclerosis)
ICD-10: G12.21
LCD L34538 Eligibility Criteria
Part II required for all diagnoses:PPS <70 AND dependence in 2+ ADLs. These apply in addition to diagnosis-specific criteria below.
- 1ALS with rapid progression (lost ≥1 functional ability in past 12 months)
- 2Critically impaired breathing (forced vital capacity <30% predicted), OR
- 3Nutritional compromise requiring PEG or NG tube, OR
- 4Major ADL dependence in 2+ categories: bathing, dressing, toileting, transferring, ambulation
Charting Tips for Audit Defense
- →Document speech intelligibility: 'less than 25% intelligible to strangers'
- →Record FVC if available with date and source
- →Note whether patient is using BiPAP and hours of use
- →Document rate of progression: what they could do 6 months ago vs now
- →Track weight and dysphagia status
Common Documentation Mistakes
✕Documenting ALS without showing rate of progression
✕Not addressing breathing impairment — it's the primary life-limiting factor
✕Missing functional decline timeline
Sample Note Findings (LCD-Aligned)
These examples show the level of specificity needed to survive ADR review. Generic language will not suffice.
ALS with rapid progression. Comparison to 6 months ago: was ambulatory with cane → now wheelchair-bound; was speaking in full sentences → now <25% intelligible with AAC device.
FVC 22% predicted per pulmonology 03/15/2026. Patient using BiPAP 18–20 hours/day. Declined tracheostomy and vent after family discussion.
Dependent in all ADLs. Requires hoyer lift for transfers. Full assist with bathing, dressing, toileting. Feeding: wife places spoon; patient unable to self-feed due to arm weakness.
Dysphagia: modified texture diet (pureed), thin liquids cleared by SLP. Family trained in Heimlich maneuver.
NotePush generates als-aligned notes automatically
Every note maps to the LCD criteria for als. Free to try with synthetic patients — no PHI required until you sign a BAA.
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