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Hospice documentation guide
End-Stage Cardiac Disease (Heart Failure)
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.
- NYHA Class IV heart failure (symptoms at rest or with minimal exertion)
- Ejection fraction ≤20%, OR significant valvular disease not amenable to repair/replacement
- Optimally treated with maximal tolerated diuretics and vasodilators
- May also qualify with treatment-refractory arrhythmia
- PPS below 70
- Dependence in 2+ ADLs
Charting Tips for Audit Defense
- Document NYHA Class IV explicitly with functional description: 'symptoms at rest'
- Record ejection fraction with source: 'EF 15% per echo 02/2026 per Dr. Smith'
- Note diuretic regimen and dose: 'Lasix 80mg BID at maximum tolerated dose'
- Document hospitalizations for CHF exacerbation: frequency, dates
- Track dyspnea at rest, orthopnea, lower extremity edema at every visit
Common Documentation Mistakes
Documenting EF without the date or ordering physician
NYHA Class III instead of IV. Class III is 'symptoms with less than ordinary activity'; IV is 'symptoms at rest'
Not documenting that therapy is maximal. Auditors look for this
Missing the PPS assessment
Not linking fluid restriction, low-sodium diet, and activity restrictions to the care plan
Sample Note Findings (LCD-Aligned)
These examples show the level of specificity needed to survive ADR review. Generic language will not suffice.
NYHA Class IV CHF: patient dyspneic at rest, unable to perform any activity without distress. Cannot speak full sentences without pausing to breathe.
EF 15% per echocardiogram 02/14/2026, Dr. Rivera. No surgical intervention planned. ICD declined by patient.
On maximum tolerated diuresis: Lasix 80mg BID, Aldactone 25mg daily, Metolazone 2.5mg PRN. Cardiology agrees no further upward titration tolerable without renal compromise.
Lower extremity edema 3+ pitting to knee bilaterally. Weight up 4 lbs since last visit despite diuretics.
PPS 30: confined to bed or chair >50% of day, unable to do any work, requiring significant assistance with self-care, intake reduced.
NotePush generates cardiac-aligned notes automatically
Every note maps to the LCD criteria for cardiac. Free to try with synthetic patients. No PHI required until you sign a BAA.
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