Wiki Hospice primary diagnosis codes for fractures

[jmesserli]

Hi, I work for a company that provides hospice services. A provider posed the following questions:

I have a couple of new hospice referrals with recent hip fractures who are declining since the fracture. If they do not meet the criteria for dementia or other typical primary hospice diagnoses such as CHF, how would you code them? Is there any way to code a fracture as a primary hospice diagnosis. We know that older people with hip fractures often die from various complications.

I have done a lot of research but haven't come up with anything definitive. Can anyone shed some light on these questions?

 

[joannl]

I have been a hospice biller/coder for 14 years. I wouldn't use the fracture as a primary dx. Look who referred the patient, why did they refer the patient, the fracture most likely isn't what a patient would expire from. Look for diagnoses that makes the patient eligible for Hospice, without the fracture, first. When our hospice isn't sure which dx to use as primary, we have our medical director review the records and he decides which is primary as he is the one who signs the certification for Hospice services.

 

[jmesserli]

Hi Joann,
I really appreciate the input! I’m sorry, now looking back at my post, I can see I wasn’t clear. This question came to my coding partner as well as myself from the doctor who is reviewing the hospice referral to see if the patient is still eligible. This patient had surgery for a hip fracture and had been declining ever since, but there is no real diagnosis she can pinpoint that is typically used as a hospice primary other than the symptoms she is seeing, to get her into the hospice program. She still feels that this patient should be eligible.The decline is from having the surgery. Do you have any suggestions on what code could be used, or maybe she just isn’t eligible?!?! I hope I am being clear with this...

 

[csperoni]

The Medicare criteria for hospice is terminal illness with less than 6 months life expectancy. I don't think a hip fracture would qualify for this (even with declining), unless there is some other illness that is terminal. If there are significant complications that are causing a terminal illness, that may meet the criteria and that is what should be coded. Why did the other doctor refer patient to hospice? Did they complete the hospice certification form?