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Hospice documentation guide
Dementia (Alzheimer's and Related Disorders)
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.
- FAST Stage 7A or above (fewer than 6 intelligible words per day; numeric encoding ≥7.1)
- Dependence in 2+ ADLs (bathing, dressing, toileting, transferring, feeding)
- PPS below 70
- At least one secondary condition: aspiration pneumonia, septicemia, pyelonephritis, pressure ulcer Stage 3–4, recurrent fever, or ≥10% weight loss in 6 months
Charting Tips for Audit Defense
- Document FAST stage explicitly at every visit. Never just 'advanced dementia'
- Count and name the fewer than 6 words patient can say; quote them
- List each ADL dependency by name: bathing, dressing, toileting, transferring, feeding
- Record weight at every visit; track percentage lost from baseline
- Name the secondary condition with dates: 'aspiration pneumonia per chest X-ray 04/12/2026'
Common Documentation Mistakes
Documenting FAST 7 instead of 7A. Plain 7 is NOT sufficient; must be 7A or higher (≥7.1)
Writing 'dependent in ADLs' without naming the specific activities
Omitting the secondary condition. It's required for dementia, not optional
Copy-forward notes that don't show progression between visits
Documenting weight only at admission, not serially
Sample Note Findings (LCD-Aligned)
These examples show the level of specificity needed to survive ADR review. Generic language will not suffice.
Patient is at FAST Stage 7A. Speech is limited to fewer than 6 recognizable words ('Mama,' 'No,' occasionally 'Stop'). FAST 7A confirmed 05/01/2026.
Patient is dependent in all 5 ADLs: bathing (requires full assist), dressing (requires full assist), toileting (incontinent, requires full assist with hygiene), transferring (requires 2-person assist), feeding (requires full assist with pureed diet via hand-over-hand cueing).
Weight 102 lbs today vs 115 lbs on 11/15/2025. Loss of 13 lbs (11.3%) over 6 months despite appetite stimulant trial. Consistent with terminal dementia trajectory.
PPS 30: mainly in bed, unable to do any work, completely unable to perform self-care, intake minimal, drowsy or confused.
Secondary: aspiration pneumonia, treated with oral antibiotics 04/03/2026 per attending Dr. Chen. Recurrent aspiration events per caregiver and family report.
NotePush generates dementia-aligned notes automatically
Every note maps to the LCD criteria for dementia. Free to try with synthetic patients. No PHI required until you sign a BAA.
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