Medicare Guidelines for Non-Cancer

ALZHEIMER’S DISEASE

ALZHEIMER’S DISEASE

  1. FAST Score (must be 7 or above)

·       (7a) Speaks, 6 intelligent words or less

·       (7b) All intelligible vocabulary lost

·       (7c) Non-ambulation

·       (7d) Can’t sit without assistance

·       (7e) Loss of ability to smile

·       (7f) Unable to hold up head independently

 

  2. Comorbid or secondary conditions such as:

·       COPD

·       CHF

·       Fever recurrent after antibiotics

·       Recurrent aspiration pneumonia

·       Sepsis/ Septicemia

·       Upper UTA (e.g. pyelonephritis)

·       Progressive weight loss > 10% in past 6 months

·       Serum albumin < 2.5 gm/dl

·       Age > 70

·       Aspiration Pneumonia

·       Decubitus ulcers (multiple stage 3 –4)

 

ICD-9 Codes that support medical necessity:

o   290.3 Senile dementia with delirium

o   331.0 Alzheimer’s disease

o   331.33 Pick’s disease

o   331.2 Senile degeneration of the brain