Clinical concerns, Hospice, ICD-10, News

Proposed hospice rule shows Alzheimer’s is top diagnosis

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Now that Alzheimer’s disease has risen to become by far the most commonly used hospice claims-reported diagnosis, hospices must be even more certain that their documentation for Alzheimer’s patients can withstand auditor scrutiny.

G30.9 (Alzheimer’s disease, unspecified) was listed as a principal diagnosis 155,066 in the 2017 fiscal year.

That’s roughly twice as often as any other principal diagnosis, according to the 2019 proposed hospice payment rule posted April 27.

While Alzheimer’s was a principal diagnosis about 163,000 times in the 2016 fiscal year, the ICD-9 code for Alzheimer’s — 331.0 — only was used as the principal diagnosis 79,626 times in the FY2013. That made it the fifth most commonly used.

Some Alzheimer’s patients could potentially live for years, but hospice patients are supposed to live six months or less.

The average lifetime length of stay in hospice when the level of care was routine home care at admission was 113.5 days in the 2017 fiscal year, the rule states. By comparison, beneficiaries with chronic, progressive neurological diseases such as Alzheimer’s disease and related dementias, and Parkinson’s disease had the longest average lifetime lengths of stay at 177.0 days when the level of care was routine home care at admission.

So it’s vital for Alzheimer’s patients’ documentation to indicate why hospice care was necessary or continues to be.

Absence of debility shifts data

Part of the increase in utilization of Alzheimer’s disease, unspecified for hospices comes because two of the six most commonly listed diagnoses in FY2013 — debility unspecified and adult failure to thrive — no longer can be coded as a principal diagnosis, CMS says.

In the FY2016 hospice final payment rule, CMS reminded the industry that claims would start being returned to providers effective Oct. 1, 2014, if hospices used codes for debility and failure to thrive.

When the code for “dementia” began to rise among principal diagnoses after this announcement, CMS told hospices not to list this manifestation code as the principal diagnosis, industry experts say. That has directly led to an increase in the use of G30.9.