Pulmonary Disease/COPD (Chronic Obstructive 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.
    4. 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
    5. 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

See another guide:
CVA (Stroke)/Coma
Heart Disease/CHF (Congestive Heart Failure)
Huntington’s Disease
Liver Disease
Neurological Diseases (see list below)
      ALS (Amyotrophic Lateral Sclerosis)
      Muscular Dystrophy
      Myasthenia Gravis
      MS (Multiple Sclerosis)
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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