HOSPICE RENAL DISEASE
[01/29/1998]
LMRP DESCRIPTION:
Medicare coverage of hospice care depends upon a physician's certification of an individual's prognosis of a life expectancy of six months or less if the terminal illness runs its normal course. Recognizing that determination of life expectancy during the course of a terminal illness is difficult, this intermediary has established medical criteria for determining prognosis of non-cancer diagnoses. These criteria form a reasonable approach to the determination of life expectancy based on available research, and may be revised as more research is available. Coverage of hospice care for patients not meeting the criteria in this policy may be denied. However, some patients may not meet the criteria, yet still be appropriate for hospice care, because of other comorbidities or rapid decline. Coverage for these patients may be approved on an individual consideration basis.
INDICATIONS AND LIMITATIONS OF COVERAGE AND/OR MEDICAL NECESSITY:
Patients will be considered to be in the terminal stage of renal disease (life expectancy of six months or less) if they meet the following criteria:
Acute renal failure (1, 2, and 3 must be present; factors from 4 will lend supporting documentation):
1. The patient is not seeking dialysis or renal transplant
2. Creatinine clearance <10 cc/min (<15 cc/min. for diabetes)
3. Serum creatinine >8.0 mg/dl (>6.0 mg/dl for diabetes)
4. Comorbid conditions:
a. Mechanical ventilation
b. Malignancy (other organ system)
c. Chronic lung disease
d. Advanced cardiac disease
e. Advanced liver disease
f. Sepsis
g. Immunosuppression/AIDS
h. Albumin <3.5 gm/dl
i. Cachexia
j. Platelet count <25,000
k. Disseminated intravascular coagulation
l. Gastrointestinal bleeding
Chronic renal failure (1, 2, and 3 must be present; factors from 4 will lend supporting documentation):
1. The patient is not seeking dialysis or renal transplant
2. Creatinine clearance <10 cc/min (<15cc/min for diabetes)
3. Serum creatinine >8.0 mg/dl (>6.0 mg/dl for diabetes)
4. Signs and symptoms of renal failure:
a. Uremia
b. Oliguria (<400 cc/day)
c. Intractable hyperkalemia (>7.0) not responsive to treatment
d. Uremic pericarditis
e. Hepatorenal syndrome
f. Intractable fluid overload, not responsive to treatment.
