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Hospice documentation guide
Stroke and Coma (Cerebrovascular Disease)
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.
- Stroke with severe functional deficits not expected to improve further
- OR coma of any etiology
- KPS/PPS ≤40
- Post-stroke complications: aspiration pneumonia, septicemia, renal failure, dysphagia, bowel/bladder incontinence, pressure ulcers
- Dependence in 2+ ADLs
Charting Tips for Audit Defense
- Document PPS 40 or below with functional description (not just score)
- Note inability to improve further from a rehabilitation standpoint
- List post-stroke complications present
- Record feeding status: PEG, dysphagic, texture-modified
- Document neurological status and cognition at every visit
Common Documentation Mistakes
PPS above 40 without strong supporting language for hospice eligibility
Not documenting that rehabilitative potential is exhausted
Missing post-stroke complications
Sample Note Findings (LCD-Aligned)
These examples show the level of specificity needed to survive ADR review. Generic language will not suffice.
Massive right MCA stroke 01/08/2026, per hospital records. Transferred to SNF 01/22/2026. No further rehabilitation potential per PT/OT evaluation 02/15/2026.
PPS 30: patient is bedridden >95% of day. Unable to perform any self-care. Requires repositioning by staff q2h for pressure injury prevention. Intake minimal.
Post-stroke complications present: dysphagia (PEG placed 01/30/2026), urinary incontinence (Foley), left-side neglect, non-verbal. Aspiration pneumonia 03/22/2026 treated with IV antibiotics in SNF.
Left hemiplegia complete, no purposeful movement in left extremities. Able to follow 1-step verbal commands intermittently. GCS 9 today (E3V2M4).
NotePush generates stroke-aligned notes automatically
Every note maps to the LCD criteria for stroke. Free to try with synthetic patients. No PHI required until you sign a BAA.
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