# Primary hospice diagnoses accepted by Medicare



## hanihosni (Feb 22, 2018)

Are the diagnoses of myocardial infarction and cerebrovascular accident acceptable primary hospice diagnoses for Medicare reimbursement ?


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## mitchellde (Feb 22, 2018)

For the Acute MI you should follow the coding guidelines as the code depends on date of onset for the Acute MI.  For the CVA they would not be in hospice with a diagnosis of an acute CVA( I63 code).  It would either be documented as a history of the CVA (Z code) or late effects of having had a CVA(I 69 code).


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## hanihosni (Feb 22, 2018)

It is stated in the guidelines that if it is still within 4 weeks or less, the myocardial infarction code can be reported. Does this mean that Medicare would reimburse a hospice if it uses this diagnosis as a primary hospice diagnosis within the 4 week time frame ?


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## jademartinez (May 24, 2018)

*Hospice Coding*

CVA code is only reserved for an acute " its happening right now" stroke.
What is coded as a terminal hospice diagnosis is the residual effect/sequela that are the result of the acute stroke.
Many of the codes require a 2nd code to provide more specific information about the residual deficit.
Example: Terminal diagnosis: Dysphagia ( difficulty swallowing)as a sequela of CVA  i69391
Guidelines will instruct you to add an additional code to identify the type of dysphagia (r1310-r1319)
The medical record usually shows the phase of dysphagia on the swallowing test that is almost always done in the hospital after a patient has a stroke.


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