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Pulmonary Disease

Pulmonary Disease - For Physicians

1a.  Disabling dyspnea at rest

1b.  Poorly or unresponsive to bronchodilators

1c.  Decreased functional capacity, e.g., bed to chair existence, fatigue, and cough

  • An FEV1 < 30% is objective evidence for disabling dyspnea but is not requires


2.  Progression of end stage pulmonary disease, as evidenced by increasing visits to emergency department or hospitalizations for pulmonary infections and/or respiratory failure or increasing physician home visits prior to initial certification


3. Documentation within the past three months of a or b:

a.  Hypoxemia at rest (pO2 < 55 mmHg by ABG) or oxygen saturation < 88%

b.  Hypercapnia evidenced by pCO2 > 50 mmHg

Supporting evidence for hospice eligibility:

  • Cor pulmonale and right heart failure secondary to pulmonary disease
  • Unintentional progressive weight loss > 10% over preceding six 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.