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Hospice documentation guide
General Decline / Debility
ICD-10: R64 / R54
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.
- 1Multiple comorbidities with documented progression
- 2PPS below 40, declining over 6-month period
- 3Nutritional impairment: weight loss ≥10% in 6 months, serum albumin <2.5 g/dL
- 4Dependence in multiple ADLs
- 5Recurrent infections, complications, or hospitalizations
Charting Tips for Audit Defense
- →List all active diagnoses contributing to decline
- →Document serial weight and PPS across multiple visits to show trajectory
- →Cite lab values with dates: albumin, pre-albumin, CBC
- →Note hospitalizations in the prior 6 months as markers of fragility
- →Describe functional state now vs 6 months ago explicitly
Common Documentation Mistakes
✕Single visit documentation without trajectory — auditors need a trend
✕No weight measurements or lab values cited
✕Vague language: 'patient is very ill' vs. specific measurements
✕Not listing all active diagnoses
Sample Note Findings (LCD-Aligned)
These examples show the level of specificity needed to survive ADR review. Generic language will not suffice.
Active comorbidities: CHF (NYHA III), COPD (on home O2 3L NC), Type 2 DM with peripheral vascular disease, and severe peripheral neuropathy. No single diagnosis terminal; combination producing terminal trajectory.
PPS trend: 60 on 11/01/2025 → 50 on 01/15/2026 → 40 on 03/20/2026 → 30 today 05/28/2026. Consistent decline over 7 months.
Weight trend: 154 lbs (baseline 11/2025) → 140 lbs (02/2026) → 128 lbs today (05/2026). Total loss: 26 lbs (16.9%) over 6 months. Albumin 2.1 g/dL per labs 05/15/2026.
Three hospitalizations in past 6 months: UTI/urosepsis (02/2026, 5-day stay), CHF exacerbation (03/2026, 4-day stay), aspiration pneumonia (05/2026, 6-day stay). Discharged on hospice.
NotePush generates general decline-aligned notes automatically
Every note maps to the LCD criteria for general decline. Free to try with synthetic patients — no PHI required until you sign a BAA.
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