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Hospice documentation guide
End-Stage Cardiac Disease (Heart Failure)
ICD-10: I50.x
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.
- 1NYHA Class IV heart failure (symptoms at rest or with minimal exertion)
- 2Ejection fraction ≤20%, OR significant valvular disease not amenable to repair/replacement
- 3Optimally treated with maximal tolerated diuretics and vasodilators
- 4May also qualify with treatment-refractory arrhythmia
- 5PPS below 70
- 6Dependence 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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