Hospice, Inc.

Metropolitan

    
Guide to Eligibility  Diagnoses   Q & A
Liver Disease
© 2004 Metropolitan Hospice Inc. All rights reserved

The patient has both the following:

1. Synthetic failure as demonstrated either of the following:
  • Prothrombin time (PT) prolonged more than 5 seconds over control
  • International Normalized Ratio (INR) >1.5
  • Serum albumin < 2.5 gm/dl
AND
2. End-Stage liver disease is present, and the patient has one or more of the following conditions:
  • Ascites, refractory to treatment or patient declines or is non-compliant
  • History of spontaneous bacterial peritonitis
  • Hepatorenal syndrome (elevated creatinine with oliguria [<400 ml/day])
  • Hepatic encephalopathy, refractory to treatment or patient on-compliant
  • History of recurrent variceal bleeding despite intensive therapy or patient declines sclerosing therapy
    Supporting Document
    Supporting conditions include: progressive malnutrition, muscle wasting with reduced strength, ongoing alcoholism (.80gm ethanol/day), hepatocellular carcinoma, Hepatitis B surface antigen positive, Hepatitis C refractory to interferon treatment.
    In the absence of one or more of the above findings, rapid decline or comorbidities may also support eligibility for hospice care.