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Hospice documentation guide
End-Stage Cancer
LCD L34538 Eligibility Criteria
Part II required for all diagnoses:PPS <70 AND dependence in 2+ ADLs. These apply in addition to diagnosis-specific criteria below.
- Locally advanced or metastatic cancer no longer responding to curative treatment, or patient declining further curative treatment
- KPS or PPS below 70
- Rapid functional decline since last clinical assessment
- Impaired nutritional status: weight loss >10% in prior 6 months, or serum albumin <2.5 g/dL if measured
Charting Tips for Audit Defense
- Document oncology's staging: metastatic, sites of metastasis
- Quote the line from the oncology note or discussion: 'Patient elected comfort-focused care per oncology visit 03/12/2026'
- Record weight and calculated percentage loss at every visit
- Note pain management regimen and effectiveness
- Document functional decline in concrete terms, not just 'weakening'
Common Documentation Mistakes
Not documenting that curative treatment has ended or been declined
Omitting metastatic staging. Auditors need to see it's not early-stage cancer
No serial weight measurements to show trajectory
Pain management documented but effectiveness not assessed
KPS/PPS score stated without supporting functional description
Sample Note Findings (LCD-Aligned)
These examples show the level of specificity needed to survive ADR review. Generic language will not suffice.
Metastatic non-small cell lung cancer (NSCLC), Stage IV with hepatic and bone metastases. Per oncology visit 04/10/2026, patient elected comfort-focused care; no further chemotherapy planned.
Weight 118 lbs today vs 136 lbs on 12/01/2025. 18 lb loss (13.2%) over 7 months. Patient and family attribute to anorexia and disease progression.
Pain: 7/10 prior to opioid dose. Currently on MS Contin 30mg q12h + MSIR 10mg q4h PRN breakthrough, using 3–4 breakthrough doses per day. Pain 4/10 at rest post-medication.
PPS 40: mainly in bed or chair, unable to do most work or activity, requires significant assistance with self-care, intake markedly reduced.
Patient declined further staging scans. Goals of care are comfort. Family and patient verbalized understanding of 6-month prognosis.
NotePush generates cancer-aligned notes automatically
Every note maps to the LCD criteria for cancer. Free to try with synthetic patients. No PHI required until you sign a BAA.
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