Thursday, October 2, 2014

Explanation on Hospice Q5003 and Q5004

CMS issued Transmittal 3032 which covered many issues facing hospices beginning on October 1, 2014.  This included non-allowable primary diagnoses, Notice of Election changes and penalties, and an explanation on hospice use of Q5003 compared to Q5004.

 

According to the CMS Transmittal 3032, Q5004 shall be used for patients in a skilled nursing facility (SNF), or hospice patients in the SNF portion of dually-certified nursing facility.  There are 4 situations where this would occur:
  1. If the beneficiary is receive hospice care in a solely-certified SNF
  2.  If the beneficiary is receiving general inpatient care in the SNF
  3. If the beneficiary is in a SNF receiving SNF care under the Medicare SNF benefit for a condition unrelated to the terminal illness and related conditions, and is receiving hospice routine home care, this is uncommon.
  4. If the beneficiary is receiving impatient respite care in a SNF
If a beneficiary is in a nursing facility but doesn't meet the above criteria for Q5004, the site shall be coded as Q5003, for a long term care nursing facility.

For more information please read the link below 
 

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