Parkinson's Disease

Parkinson's Disease

Parkinson's Disease

LCD Guideline

Parkinson's Disease

The patient must meet at least one of the following criteria (1 or 2):

1. Severely impaired breathing capacity with all of the following findings: Dyspnea at rest, vital capacity less than 30%, the requirement of supplemental oxygen at rest, the patient declines artificial ventilation

OR

2. Rapid disease progression and either a or b below:

Progression from independent ambulation to wheelchair or bedbound status

Progression from normal to barely intelligible or unintelligible speech

Progression from normal to pureed diet

Progression from independence in most or all Activities of Daily Living (ADL) to needing major assistance by caretaker in all ADL

AND

a. Severe nutritional impairment demonstrated by all of the following in the preceding twelve (12) months: Oral intake of nutrients and fluids insufficient to sustain life Continuing weight loss Dehydration or hypovolemia

Absence of artificial feeding

OR

b. Life-threatening complications demonstrated by one or more of the following in the preceding twelve (12) months: Recurrent aspiration pneumonia (with or without tube feedings), Upper urinary tract infection (e.g.,

Pyelonephritis), Sepsis, Recurrent fever after antibiotic therapy, Stage 3 or 4 decubitus ulcer(s)

In the absence of one or more of these findings, rapid decline or comorbidities may also support eligibility for hospice care.

Comparative Data

Fast Score - On admission fast 7a now 7e

PPS score change - On admission PPS 50%, now PPS 40%

Intake - Was eating 100% of meals now only eats 50% meals

Patient now is pocketing food

Patient had a change in diet from regular to pureed diet

Patient previously could eat independently now needing cues to eat

Weight change - Patient has lost 10lb since admission

Alertness - On admission patient was sleeping 10 hours a day, now sleeping 15 hours a day •

Patient has become combative with cares, needs medication intervention for behaviors

Skin issues - Redness noted to coccyx, previously had no skin issues

Activity - Can no longer propel him/herself in wheelchair, on admission could propel around independently

Need for lateral supports, patient now leaning in wheelchair and needs support laterally

Change in ADL’s - Patient was a one person transfer one month ago, today is 2 person transfer, patient was a 2 person transfer and is now a Hoyer lift

New infections, Recurrent Infections

Fever noted, recurrent fever

Comorbidities

Kidney failure Anorexia

Pain Ascites

SOB Edema

Bleeding Weight Gain

Syncopal Episodes