Medicare guidelines for hospice eligibility for patients with liver disease^[1]

Liver disease

Patients will be considered to be in the terminal stage of liver disease (life expectancy of six months or less) if they meet the following criteria (1 and 2 should be present; factors from 3 will lend supporting documentation):

Both prolonged prothrombin time (more than five seconds over control, or INR >1.5) AND serum albumin <2.5 g/dL.

End stage liver disease with at least one of the following: Ascites, refractory to treatment or patient non-compliant; spontaneous bacterial peritonitis; hepatorenal syndrome (elevated creatinine and BUN with oliguria [<400 mL/day] and urine sodium concentration <10 mEq/L); hepatic encephalopathy refractory to treatment or patient non-compliant; recurrent variceal bleeding, despite intensive therapy.

Documentation of the following factors will support eligibility for hospice care: Progressive malnutrition; muscle wasting with reduced strength and endurance; continued active alcoholism (>80 g ethanol/day); hepatocellular carcinoma; HBsAg; hepatitis C infection refractory to interferon treatment.

INR: international normalized ratio; BUN: blood urea nitrogen; HBsAg: hepatitis B surface antigen positivity.

Reference:

Centers for Medicare & Medicaid Services. Local Coverage Determination (LCD) for Hospice Determining Terminal Status (L33393) (Accessed on January 18, 2016).

Graphic 106152 Version 2.0

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Medicare guidelines for hospice eligibility for patients with liver disease[1]

Medicare guidelines for hospice eligibility for patients with liver disease^[1]