Healthcare Professionals

Hospice of Montgomery treats patients of all faith communities. Our services are available 24 hours a day, 7 days a week and we will respond promptly to your needs. We are committed to serving the people of Montgomery, Autauga, Elmore, Crenshaw, and Butler counties. All appropriate patients are eligible for our full range of services—regardless of diagnosis, age or the ability to pay.

  • If making a referral on the weekend, after hours or you require a more immediate follow-up, please call us at 334-279-6677 and the on call RN will return your call promptly.

    • Make a Referral

      Download our Physicians Referral Form. Fax History and Physical/notes to our office at 334-277-2223.

       

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    • Benefits of an Early Referral

      “I wish we had been referred to Hospice sooner.”

      At any time during a life-threatening illness, and preferably before the stress of a crisis, it is appropriate to discuss all of a patient’s healthcare options, including hospice. Many physicians are hesitant to talk to their patients about hospice for fear of destroying their hope; however, many patients and families are relieved to have their physician initiate the conversation so that they can maximize their quality of life. But sadly, while hospice care is most effective over a period of months, almost 33% of those served by hospice died within 7 days.*

      Yet, by providing the option of hospice sooner, you as a physician can continue to make positive changes in the lives of your patients. Hospice is a positive option, one that seeks to provide comfort and freedom from pain and other symptoms. By understanding and accepting that death is part of the life cycle, Hospice of Montgomery wants to assist you in helping you patients make life its most meaningful until the end of life. Pain and symptom management is just one of the benefits of an early hospice referral. Patient participation in all planning and decisions is another important benefit.

      Before the stress of a medical crisis, early discussions about hospice can facilitate open communication and provide patients a choice and a sense of control. Early referral to hospice allows the patient’s family time to prepare for the changes they face, giving them time to say goodbye, and decreasing the chance that the family’s grief will be prolonged and complicated.

      • Pain and symptoms are addressed sooner and crises can be avoided.
      • Hospitalization can be reduced or eliminated.
      • Advance directives can be prepared to avoid difficult decisions later.
      • Patients benefit from sustained relationships with the hospice team.

       

      Because end-of-life discussions are difficult, a Hospice of Montgomery staff member is always available to meet at your office and assist you in providing a complete consultation about our services with the patient and their family.

      Helping live each of life’s moments to the fullest, with those who matter the most. That’s what we do at Hospice of Montgomery. To find out more about Hospice of Montgomery and the services we provide, call 334-279-6677.

      *(Source: Koroukian, Siran M.; Fambro, Tiann (2008). “Hospice”. in Loue, Sana; Sajatovic, Martha; Koroukian, Siran. Encyclopedia of Aging and Public Health. Springer. p. 441.)

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  • When curative treatment is no longer effective or appropriate, Hospice of Montgomery focuses on providing the best quality of life possible.

    You can continue as the patient’s primary physician, or your patient can be closely followed by our Medical Director, and you will be updated on your patient’s progress throughout the hospice experience. When making a referral, be sure to mention Hospice of Montgomery by name. Coverage of hospice care depends upon a physician’s certification that a patient’s life expectancy is six months or less if the illness runs its normal course. Recognizing that determination of life expectancy during the course of a terminal illness is difficult, the Center for Medicare and Medicaid Services (CMS) has published medical criteria, which addresses several of the concerns that many physicians have had regarding the Hospice Medicare Benefit.

    This memorandum states in part:

    “…physicians and other health care practitioners can be encouraged that the Medicare program includes a hospice benefit that provides coverage for a variety of services and products designed for those with terminal diagnoses. When properly certified and appropriately managed, hospice care is a supportive and valuable covered treatment option… Hospice is not about death, but rather about the quality of life as it nears its end, for all concerned the patient, family and friends, and for the health professional community.

    Physicians and health care providers in the community, skilled nursing facilities, and hospitals are urged to raise awareness among their patients about the hospice benefit and its availability. Further, a beneficiary may independently elect hospice care. The beneficiary may discuss this option in the event that he or she has a terminal diagnosis; however, in all such cases, a physician must certify that the beneficiary has a terminal diagnosis with a six month prognosis, if the illness runs its usual course.

    Hospice care that is covered by Medicare is chosen for specified amounts of time known as “election periods”. Essentially, a physician may certify a patient for hospice care coverage for two initial 90-day election periods, followed by an unlimited number of 60-day election periods. Each election period requires that the physician certify a terminal illness.

    Generally speaking, the hospice benefit is intended primarily for use by patients whose prognosis is terminal, with six months or less of life expectancy. The Medicare program recognizes that terminal illnesses do not have entirely predictable courses; therefore, the benefit is available for extended periods of time beyond six months provided that proper certification is made at the start of each coverage period.

    Recognizing that prognoses can be uncertain and may change, Medicare’s benefit is not limited in terms of time. Hospice care is available as long as the patient’s prognosis meets the law’s six month test.”

    This test is a general one. As the governing statute says:

    “The certification of terminal illness of an individual who elects hospice shall be based on the physician’s or medical director’s clinical judgment regarding the normal course of the individual’s illness.” CMS recognizes that making medical prognostication of life expectancy is not always an exact science. Thus, physicians need not be concerned. There is no risk to a physician about certifying an individual for hospice care that he or she believes to be terminally ill.”

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  • The information contained in this document is intended to serve as a guide only; it is not intended to be viewed as billing advice. Physicians should still refer to the CMS Medicare Claims Processing Manual (Publication 100-4, Medicare Claims Processing, Chapter 11) for specific Medicare guidelines and instructions related to billing.

    The following information is for patients accessing the Hospice Medicare Benefit (HMB) 
    Physician Type Service Source Who Bills Modifier Code
    Attending Professional Medicare Part B Physician bills Medicare B carrier Use “GV” for services related to terminal illness
    Attending Technical Hospice daily rate Physician bills HPCCR N/A
    Attending Administrative Medicare Part B1,2,3,4 Physician bills Medicare B carrier G01825
    Consulting Professsional Medicare Part A Physician bills HPCCR6 N/A
    Consulting Technical Hospice daily rate Physician bills HPCCR6 N/A

    1 Payment is available for one physician per month involving 30 minutes of the physician’s time per month.

    2 Must not submit the claim until after the end of the month in which the service is performed.

    3 Must report care planning only once per calendar month.

    4 Use CPT code 99377 for 15-29 minutes per month; use code 99387 for 30 minutes or more (reimbursement not increased for documenting more than 30 minutes)

    5 HCPCS code G0182 must be the first and last date during which documented care planning services were actually provided during the calendar month (not the first and last calendar date of the month in which the claim in submitted)

    6The physician bills Hospice of Montgomery who then bills Medicare Part A for both professional and technical services.

    Billing Definitions

    The attending physician is the physician designated by the patient to have the most significant role in the determinations and delivery of the patient’s medical care while under the Hospice Medicare Benefit during the election process. The primary physician, as indicated on the Notice of Election (NOE), is the attending physician.

    The consulting physician is the physician, other than the attending, who provides direct patient care at the request of the hospice interdisciplinary team, for a condition related to the terminal illness.

    *The physician must have a contract with Hospice of Montgomery*

    The covering physician is the physician who has reciprocal billing arrangements with another physician or another member of the physician’s group under the following guidelines:

    • The attending physician is unavailable to provide the services.
    • The patient sought the visit with the attending physician.
    • The covering physician does not provide services to the patient for a continuous period of longer than 60 days.

    *Bill according to Attending Physician guidelines, but use Q5 in item 24D of the HCFA 1500.*

    Professional services are the actual procedures performed by the physician as designated by the appropriate CPT-4 code. Examples include patient visits, procedures, physician interpretation of x-rays, CT scan, MRI or physician interpretation of a laboratory test.

    *Look up the code in the CPT-4 Code book to ensure that the service was a professional service and not technical or administrative.*

    Technical services include labs, x-rays, and any other non-professional services performed by the physician or other health care professional required for the management of the terminal illness.

    Administrative services include participating in the establishment, review, and updating of the plan of care, supervising care and services, and establishing governing policies.

    *Bill Medicare Part B, Code G0182.*

    Other General Information

    • Any physician, attending or consultant, who provides services to hospice patients not related to the terminal illness should bill as though the patient were not on hospice.
      *Utilize Modifier code GW for services not related to the terminal illness*
    • Complexity based E&M coding may be used for any of your patient visits using the standard E&M guidelines which are based on the complexity of the history, exam, and problem solving.
    • Time based coding: if more than half of your time was spent in counseling and/or coordination of care, you may bill based on the time guidelines, regardless of the complexity. Please refer to CPT code book for specific coding guidelines.
    • Prolonged service codes may be used for a visit that lasts more than 30 minutes longer than the E&M based suggested times.
      *99356/99354: first additional 30-74 minutes*
      *99357/99355: each additional 30 minutes*

    Please direct any questions to Hospice of Montgomery 334-279-6677

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  • Hospice of Montgomery has an extensive network of community and professional educational offerings. They range from Speakers Bureau presentations at community organizations, churches, and institutions to professional presentations and continuing education units (CEU) training for nurses and other staff members at local and regional nursing homes, assisted living facilities, and hospitals. If you are planning a health or resource fair, the Speaker’s Bureau can provide a Hospice display with educational material. Our educational workshops for healthcare professionals and community education presentations include the following topics:
    • Advanced Care Planning

      This presentation looks at the an individual’s rights and how to prepare in advance for the medical, financial, and legal decisions one must make to get what is desired when they may no longer be able to make those decisions.

      Target audience: general public.

    • Hospice 101

      This presentation provides an overview of hospice services, philosophy and reimbursement. It also looks at the criteria used to determine if a patient is hospice appropriate.

      Target Audience: Clinical staff at hospitals, doctors’ offices, discharge planners, and nursing organizations.

    • Pain and Symptom Management

      This presentation explores the use of medication and other methods to control pain, nausea, restlessness, anxiety, etc. for the terminally ill patient.

      Target Audience: Clinical staff in hospitals, nursing homes, assisted living facilities, doctors’ offices, and home health agencies.

    • Ethical Issues Surrounding End-of-Life Care

      This offering is a structured discussion about decision making for withdrawal and withholding of life sustaining measures. Included in the presentation are discussions about tube feedings, code status, and other measures that may be offered as options at the end of life.

      Target audience: This presentation can be structured either for the general public or health care professionals.

    • The Tasks and Stages of Grief

      The focus of this presentation is the five stages of grief, how the progression through the stages is not always linear, and how the grief experience can vary among individuals. Three grief models will be explored.

      Target audience: This presentation can be structured either for the general public or health care professionals.

    • Dementia and Hospice Care

      This presentation explores the stages of dementia and when hospice care can be initiated to better benefit the patient and the caregiver.
      If you would like to schedule a speaker for an upcoming event or program, please contact Julia Wallace, Community Education Coordinator at 334-279-6677.
    • Alzheimer’s Disease

      1. FAST Score (must be 7 or above)

      • (7a) Speaks, 6 intelligent words or less
      • (7b) All intelligible vocabulary loss
      • (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:
      • 290.3 Senile dementia with delirium
      • 331.0 Alzheimer’s disease
      • 331.33 Pick’s disease
      • 331.2 Senile degeneration of the brain

       

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    • Heart Disease

      1. Patient is already optimally treated w/ diuretics and vasodilators (ACE Inhibitors) or Nitrates plus Hydralazine

      2. Patient has significant symptoms of recurrent CHF at rest, and is classified as a NYHA Class IV

      Supportive Documentation
      • O2 Sat. < 88%
      • Ejection Fraction of 20% or less
      • SV or Ventricular Arrythmia
      • Hx. Of Cardiac Arrest
      • Hx. Of Syncope, unexplained
      • Brain embolism
      • *If patient can’t tolerate ACE Inhibitors, MD must document why*
      ICD-9 Codes that support medical necessity:
      • 414.8 Chronic Ischemic Heart Disease
      • 424.0-428.9 Congestive Heart Failure

       

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    • Pulmonary Disease

      1. Severe chronic lung disease documented by A and B

      • A: Disabling Dyspnea at rest, poorly or unresponsive to bronchodilators, resulting in decreased functional capacity.
        *Documentation of forced expiratory volume in one second (FEV1) after bronchodilator, less than 30% predicated.*
      • B. Progression of end-stage pulmonary disease, as evidenced by prior increasing visits to the emergency department or prior hospitalizations for pulmonary infections / respiratory failure
        *Documentation of serial decrease in FEV1 on serial testing of > 40 ml per year.*

      2. Hypoxemic at rest on room air, as evidenced by:

      • pO2, < 55 mm Hg or
      • O2 saturation 88%
      • Hypercapnia (pCO2 50 mm Hg)
      Supportive Documentation
      • Cor pulmonale and right heart failure (RHF)
      • Progressive weight loss > than 10% over preceding 6 months
      • Resting tachycardia > 100/mm

       

      ICD-9 Codes that support medical necessity:

      Diagnoses for pulmonary disease, which leads to end-stage pulmonary disease, will be accepted.

       

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    • Liver Disease

      Both 1 & 2 and at least 1 of 3 must be present

      End-Stage Liver Disease must have at least one of the following:

      • Prolonged prothrombin time > 5 sec. over control orINR 1.5
      • Low serum albumin Spontaneous bacterial peritonitis
      • Hepatorenal syndrome
      • Recurrent Variceal Bleeding
      • Hepatc Encephalopathy

       

      ICD-9 Codes that support medical necessity:
      • 155.0 Liver Cancer
      • 571.2 Alcoholic Cirrhosis of liver
      • 571.40-571.49 Chronic hepatitis
      • 571.5 Cirrhosis of liver w/o mention of alcohol
      • 571.6 Biliary Cirrhosis
      • 572.2 Hepatic coma
      • 572.4 Hepatorenal syndrome

      *Local Coverage Determination Policies 2004*

       

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    • Renal Disease

      A, B, & C must be present

      1. Acute Renal Failure

      • A: Patient is not seeking dialysis or renal transplant
      • B: Creatinine clearance < 10 cc/min (< 15 cc/min for diabetes)
      • C: Serum creatinine > 8.0 mg/dl (3.0 mg/dl for diabetes)
      Supportive Documentation

      Comorbid Conditions:

      1. Mechanical Ventilation
      2. Malignancy (other organ system)
      3. Chronic lung disease
      4. Advanced cardiac disease
      5. Advanced liver disease

      • Sepsis
      • Immunosuppression / AIDS
      • Albumin < 3.5 gm/dl
      • Cachexia
      • Platelet count < 25,000
      • Disseminated intravascular coagulation
      • Gastrointestinal bleeding

      2. Chronic Renal Failure

      • A: Patient is not seeking dialysis or renal transplant
      • B: Creatinine clearance < 10 cc/min (< 15 cc/min for diabetes) C. Serum creatinine > 8.0 mg/dl (3.0 mg/dl for diabetes)
      Supportive Documentation

      Signs and symptoms of renal failure:

      • Uremia
      • Oliguria ( 10% during previous 6 months
      • Weight loss > 7.5% in previous 3 months
      • Serum albumin < 2.5 gm/dl
      • History of pulmonary aspiration
      • Inadequate caloric/fluid intake

       

      ICD9 Codes that support medical necessity:
      • 430 Subarachnoid hemorrhage
      • 431 Intracerebral hemorrhage
      • 431-436
      • 850-854
      • 997.02 Nervous system complication; iatrogenic
      • cerebrovascular infraction or hemorrhage
    • Adult Failure to Thrive

      1. BMI must be < 22 kg/m2
      2. Reason for Decline: (check all that apply)

      • Not responding to nutritional support despite adequate caloric intake
      • Patient declining enteral/parenteral support

      3. Karnofsky Score: (must be 40 or below)

      • 40 – Disabled / require much assistance / frequent medical care
      • 30 – Severely disabled / require close monitoring
      • 20 – Very sick / active supportive Tx
      • 10 – Moribund / Imminent death

      *Comorbidities increase patient’s hospice appropriateness*

       

      ICD-9 Codes that support medical necessity:
      • 783.41 Failure to Thrive
      • 783.7 Adult Failure to Thrive
      • 799.3 Debility, unspecified
      • 799.89 Other ill-defined conditions
      • 799.9 Other unknown and unspecified causes of morbidity and mortality

       

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    • ALS

      AMYOTROPHIC LATERAL SCLEROSIS (ALS)
      1. The patient has rapid progression of ALS in the preceding 12 months evidenced by:

      • Progression from independent ambulation to wheelchair or bed bound status
      • Progression from normal to barely intelligible or unintelligible speech
      • Progression from normal to pureed diet
      • Progression from independence in most or all activities of daily living (ADLs) to needing major assistance by caretaker in all ADLs.

      2. At least one of the following must also apply:

      A. Critically impaired breathing capacity evidenced by:

      • Vital capacity (VC) less than 30% of normal
      • Significant dyspnea at rest
      • Requires supplemental oxygen at rest
      • Patience declines artificial ventilation

      B. Critical nutritional impairment evidenced by:

      • Oral intake insufficient
      • Continuing weight loss
      • Dehydration or hypovolemia
      • Absence of artificial feeding methods

      B. Life-threatening complications

      • Recurrent aspiration pneumonia
      • Upper urinary tract infection (pyelonephritis)
      • Sepsis
      • Recurrent fever after antibiotic therapy

      *A physician may determine that a patient has a life expectancy of six months or less even if the above findings are not present. Co-morbidities also support eligibility for hospice care.*

       

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    • HIV

      1. CD4 + count < 25 2. Viral load > 100,000
      3. KPS 50% or less
      4. Co-morbidity factors
      5. The following HIV related opportunistic diseases are all associated with prognosis < 6 months

      • CNS Lymphoma
      • Progressive multifocal leufoencephalopathy
      • Cryptosporidiosis
      • Wasting (loss of 33% lean body mass)
      • MAC bacteremia, untreated
      • Visceral Kaposi’s sarcoma, unresponsive to therapy
      • Renal failure, refuses or fails dialysis
      • Advanced AIDS dementia complex
      • Toxoplasmosis

       

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