LCD Guideline
Cancer
A. Disease with distant metastases at presentation
OR
B. Progression from an earlier stage of disease to metastatic disease with either:
Note: Certain cancers with poor prognoses (e.g. small cell lung cancer, brain cancer and pancreatic cancer) may be hospice eligible without fulfilling the other criteria in this section.
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Comparative Data
Increase in tumor size - Tumor was size of golf ball now size of softball
Decrease in activity - Was able to go out and enjoy activity, now staying in room Comorbidities - CHF, COPD, ETC
Decrease in intake - Was eating 100% of meals 1 month ago, now eating only one meal a day, complains of change in taste
Weight Change, Anorexia
Depression and Anxiety - Was very social interacting with people, now staying in room, not talkative
Medication changes - Add anxiety medication, depression medication
Increase in Pain - Change in pain intensity, interferes with activity
Change in ADL’s - Needs assistance with bathing, needs assistance with dressing, PPS was 60% 2 months ago today, PPS 40%, increased weakness
Change in Skin - Pallor, lesions, wounds, nonhealing wounds, dusky, bruising
Comorbidities
Contact us today at
480-868-2845 if you have questions about cancer eligibility guidelines.
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