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Pulmonary Disease for Physicians

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

AND

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

AND

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.