TABLE 7.

Hospice criteria for patients with DC^[288]

Patients will be considered to be in the terminal stage of LD (life expectancy of ≤6 months) if they meet the following criteria (criteria 1 and 2 should be present; factors from criterion 3will lend supporting documentation):

1. The patient should show both a and b:

a. Prothrombin time prolonged >5 s over control or international normalized ratio >1.5;

b. Serum albumin <2.5 g/dl.

2. End-stage liver disease is present and the patient shows at least one of the following:

a. Ascites, refractory to treatment or patient noncompliant;

b. SBP;

c. Hepatorenal syndrome (elevated creatinine and blood urea nitrogen with oliguria);

d. HE, refractory to treatment or patient noncompliant;

e. Recurrent variceal bleeding, despite intensive therapy.

3. Documentation of the following factors will support eligibility for hospice care:

a. Progressive malnutrition;

b. Muscle wasting with reduced strength and endurance;

c. Continued active alcoholism (>80 g of ethanol per day);

d. HCC;

e. HBsAg positive;

f. Hepatitis C refractory to interferon treatment.Patients awaiting LT who otherwise fit these criteria may be certified for the Medicare hospice benefit; but if a donor organ is procured, the patient should be discharged from hospice.

Reference: Hospice determining terminal status. CMS. https://www.cms.gov/medicare-coverage-database/details/lcd-details.aspx?LCDId=34538. Last accessed January 7, 2022