LCD Guidelines
Pulmonary Disease
The criteria refer to patients with various forms of advanced pulmonary disease who eventually follow a final common pathway for end stage pulmonary disease. (1 & 2 should be present. Documentation of 3, 4, & 5 will be supporting documentation.)
1. Severe chronic lung disease as documented by:
A. Disabling dyspnea at rest, poorly or unresponsive to bronchodilators resulting in decreased functional capacity. e.g. bed to chair existence, fatigue, & cough. (Documentation of Forced Expiratory Volume in 1 second (FEV1) after bronchodilator, less than 30% of predicted is objective evidence for disabling dyspnea, but is not necessary to obtain.)
Comparative Data
Change in Breathing - Labored purse lip breathing, barrel chest noted, cough noted, tripod posture
Increase in SOB - Not able to ambulate or handle activity, patient used to be able to walk to bathroom not short of breath and now requires a break, does not sleep in bed anymore, prefers a recliner to sleep in
Change in Activity - Used to be involved with every activity, now does not attend activities
Change in Intake - Patient was eating 100% now only eating 50%
Infection - Pneumonia, bronchitis
Comorbidities - Increase in CHF exacerbation’s
Comorbidities
Kidney Failure
Pain
SOB
Bleeding
Anorexia
Ascites
Syncopal Episodes
Edema
Weight Gain