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Hospice documentation guide
End-Stage Liver Disease (Cirrhosis)
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.
- End-stage liver disease with Child-Pugh score Class C (≥10 points), OR
- Refractory ascites despite paracentesis, OR
- Hepatic encephalopathy (Grade 3–4 or recurrent), OR
- Spontaneous bacterial peritonitis (history of), OR
- Hepatorenal syndrome, OR
- Hepatic hydrothorax
- Not a transplant candidate OR patient declined transplant
- PPS below 70, dependence in 2+ ADLs
Charting Tips for Audit Defense
- Document Child-Pugh score components: bilirubin, albumin, PT/INR, ascites, encephalopathy
- Record frequency and volume of paracenteses
- Note whether patient is transplant candidate and why not (or why they declined)
- Track sodium level for hyponatremia (indicator of severity)
- Document encephalopathy grade and lactulose regimen
Common Documentation Mistakes
Not calculating Child-Pugh score. State the class explicitly
Documenting ascites without noting whether it's refractory
Not addressing transplant candidacy
Missing INR documentation (a Child-Pugh component)
Sample Note Findings (LCD-Aligned)
These examples show the level of specificity needed to survive ADR review. Generic language will not suffice.
Child-Pugh Class C (score 12): bilirubin 4.2 mg/dL (3 pts), albumin 2.0 g/dL (3 pts), INR 2.8 (3 pts), severe ascites requiring paracentesis (3 pts), Grade 2 encephalopathy (2 pts).
Refractory ascites: 6 paracenteses in past 4 months, most recent 04/18/2026, 5.5L removed. Patient not tolerating further spironolactone dose increase per nephrology.
Not a transplant candidate per hepatology 03/2026 due to ongoing alcohol use history and functional status. Patient declined further evaluation.
Lactulose 30mL TID with target of 2–3 soft bowel movements daily. Encephalopathy Grade 2 (disorientation, asterixis present on exam).
NotePush generates liver-aligned notes automatically
Every note maps to the LCD criteria for liver. Free to try with synthetic patients. No PHI required until you sign a BAA.
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