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Hospice documentation guide
End-Stage Renal Disease (Kidney Failure)
ICD-10: N18.6
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.
- 1Creatinine clearance <10 mL/min (GFR <10) AND serum creatinine >8.0 mg/dL (or >6.0 in diabetics)
- 2Uremia (nausea/vomiting, confusion, pruritus)
- 3Oliguria <400 mL/day or patient declining dialysis / withdrawn from dialysis
- 4PPS below 70, dependence in 2+ ADLs
Charting Tips for Audit Defense
- →Document GFR or creatinine clearance with lab date
- →Document dialysis status: declined, withdrawn, contraindicated, or not offered
- →Note uremic symptoms: pruritus, nausea, confusion, fatigue
- →Track urine output or anuria if accessible
- →Record potassium, BUN, creatinine trend
Common Documentation Mistakes
✕Not documenting the dialysis decision — auditors want to see it's not just unaddressed
✕Lab values without dates
✕Documenting 'renal failure' without creatinine/GFR data
Sample Note Findings (LCD-Aligned)
These examples show the level of specificity needed to survive ADR review. Generic language will not suffice.
ESRD, GFR 6 mL/min per labs 05/02/2026. Creatinine 9.2 mg/dL. BUN 84 mg/dL. Potassium 5.8 mEq/L.
Patient withdrew from hemodialysis 04/28/2026 after 3 years of MWF dialysis. Goals of care discussion with patient and family on 04/25/2026; patient verbalized clear preference for comfort-focused care.
Uremic symptoms present: generalized pruritus (using sarna lotion), nausea daily (Zofran 4mg q6h PRN), fatigue, and mild confusion worsening in the evenings.
Oliguria: urine output estimated at 180–220 mL/day per family report. Patient wearing brief and pad for incontinence.
NotePush generates renal-aligned notes automatically
Every note maps to the LCD criteria for renal. Free to try with synthetic patients — no PHI required until you sign a BAA.
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