Liver Disease

Must have 1 and 2.

  1. Synthetic failure as demonstrated by a or b, and c:
    1. Prothrombin time (PTT) prolonged more tan (5) seconds over control
    2. International Normalized Ratio (INR) >1.5
    3. Serum albumin <2.5 gm/dl
  2. End-Stage liver disease is present at least (1) of the following is present:
    1. Ascites, refractor to treatment or patient declines or is non-compliant
    2. History of spontaneous bacterial peritonitis
    3. Hepatorenal syndrome (elevated creatinine with oliguria [<400 ml/day])
    4. Hepatic encephalopathy, refractor to treatment or patient non-compliant
    5. History of recurrent variceal bleeding despite intensive therapy or patient declines therapy

Supporting documentation:

  • Progressive malnutrition
  • Muscle wasting with reduced strength
  • Ongoing alcoholism (>80 gm ethanol/day)
  • Hepatocellular carcinoma
  • Hepatitis B surface antigen positive
  • Hepatitis C refractory to interferon treatment

See another guide:
CVA (Stroke)/Coma
Heart Disease/CHF (Congestive Heart Failure)
Huntington’s Disease
Neurological Diseases (see list below)
      ALS (Amyotrophic Lateral Sclerosis)
      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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