Liver Disease

Must meet all criteria:

  1. Synthetic failure as demonstrated by a or b, and c:
    1. Prothrombin time (PTT) prolonged more than (5) seconds over control, or;
    2. International Normalized Ratio (INR) >1.5, and;
    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, refractory 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
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
COPD/Pulmonary Disease
CVA /Stroke/Coma
Huntington’s 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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