COPD/Pulmonary Disease

Must meet all criteria.

  1. Must have the following conditions documented:
    1. Disabling dyspnea at rest
    2. Poor response to bronchodilators
    3. Decreased functional capacity (e.g. bed to chair existence, fatigue, and cough).
      1. FEV1 <30% is objective evidence for disabling dypnea but is not required.


  2. Progression of disease as evidenced by a recent history of increased visits to PCP office, home visits, or ER and/or hospitalizations for pulmonary infections and/or respiratory failure


  3. Documentation within the past (3) months of either/both of the following:
    1. Hypoxemia at rest (pO2<55 mgHg by ABG) or oxygen saturation <88%
    2. Hypercapnia evidenced by pCO2>50mm Hg

Supporting documentation:

  • Cor pulmonale and right heart failure secondary to pulmonary disease
  • Unintentional progressive weight loss >10% over the preceeding (6) months
  • Resting tachycardia >100 bpm
In the absence of one or more of the above findings, rapid decline or comorbidities may also support eligibility for hospice care. 

Other guides:
CHF/Heart Disease
CVA /Stroke/Coma
Huntington’s Disease
Liver Disease
Neurological Diseases 
      ALS (Amyotrophic Lateral Sclerosis)
      Muscular Dystrophy
      Myasthenia Gravis
      MS (Multiple Sclerosis)
Renal Failure, Chronic or Acute

Assessment Tools
Palliative Performance Scale (PPS)
New York Heart Association (NYHA) Functional Classes
Functional Assessment Staging (FAST) Scale

Frequent Co-Morbidity documentation requirements
Cachexia or Protein Calorie Malnutrition

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