Heart Disease/CHF (Congestive Heart Failure)

Patient must have 1 and either 2 or 3.

  1. CHF with NYHA[1] Class IV symptoms and both:
    1. Significant symptoms at rest
    2. Inability to carry out minimal physical activity without angina/dyspnea
  2. Poor response to optimal treatment with diuretics, vasodilators, and/or angiotensin converting enzyme (ACE) inhibitors or patient refuses treatment.
  3. The patient has angina pectoris at rest, resistant to standard nitrate therapy, and is either not a candidate for/or declines invasive procedures.

Supporting documentation:

  • Echo demonstrating an ejection fraction of 20% or less
  • Treatment resistant symptomatic dysrythmias
  • History of unexplained or cardiac related syncope
  • CVA secondary to cardiac embolism
  • History of cardiac arrest or resuscitation

[1] Refers to the New York Heart Association Functional Classifications

See another guide:
Alzheimer’s/Dementia
Cancer
CVA (Stroke)/Coma
HIV/AIDS
Huntington’s Disease
Liver Disease
Neurological Diseases (see list below)
      ALS (Amyotrophic Lateral Sclerosis)
      Parkinson’s
      Muscular Dystrophy
      Myasthenia Gravis
      MS (Multiple Sclerosis)
Pulmonary Disease/COPD (Chronic Obstructive Pulmonary Disease)
Renal (Kidney) Failure

Frequent Co-Morbidity documentation requirements
Cachexia/Protein Calorie Malnutrition (Weight Loss)

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

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