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Hospice documentation guide
End-Stage Cancer
ICD-10: C00–C97
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.
- 1Locally advanced or metastatic cancer no longer responding to curative treatment, or patient declining further curative treatment
- 2KPS or PPS below 70
- 3Rapid functional decline since last clinical assessment
- 4Impaired nutritional status: weight loss >10% in prior 6 months, or serum albumin <2.5 g/dL if measured
Charting Tips for Audit Defense
- →Document oncology's staging: metastatic, sites of metastasis
- →Quote the line from the oncology note or discussion: 'Patient elected comfort-focused care per oncology visit 03/12/2026'
- →Record weight and calculated percentage loss at every visit
- →Note pain management regimen and effectiveness
- →Document functional decline in concrete terms, not just 'weakening'
Common Documentation Mistakes
✕Not documenting that curative treatment has ended or been declined
✕Omitting metastatic staging — auditors need to see it's not early-stage cancer
✕No serial weight measurements to show trajectory
✕Pain management documented but effectiveness not assessed
✕KPS/PPS score stated without supporting functional description
Sample Note Findings (LCD-Aligned)
These examples show the level of specificity needed to survive ADR review. Generic language will not suffice.
Metastatic non-small cell lung cancer (NSCLC), Stage IV with hepatic and bone metastases. Per oncology visit 04/10/2026, patient elected comfort-focused care; no further chemotherapy planned.
Weight 118 lbs today vs 136 lbs on 12/01/2025 — 18 lb loss (13.2%) over 7 months. Patient and family attribute to anorexia and disease progression.
Pain: 7/10 prior to opioid dose. Currently on MS Contin 30mg q12h + MSIR 10mg q4h PRN breakthrough, using 3–4 breakthrough doses per day. Pain 4/10 at rest post-medication.
PPS 40: mainly in bed or chair, unable to do most work or activity, requires significant assistance with self-care, intake markedly reduced.
Patient declined further staging scans — goals of care are comfort. Family and patient verbalized understanding of 6-month prognosis.
NotePush generates cancer-aligned notes automatically
Every note maps to the LCD criteria for cancer. Free to try with synthetic patients — no PHI required until you sign a BAA.
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