Medicare Guidelines for Non-Cancer

 

STROKE AND COMA

1.  PPS of 40%

 

  2. FAST Score (must be 7 or above)

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

o   (7b) All intelligible vocabulary lost

o   (7c) Non-ambulation

o   (7d) Can’t sit without assistance

o   (7e) Loss of ability to smile

o   (7f) Unable to hold up head independently

 

 3. Inability to maintain hydration and caloric intake

     with one of the following:

o   Weight loss > 10% during previous 6 months

o   Weight loss > 7.5% in previous 3 months

o   Serum albumin < 2.5 gm/dl

o   History of pulmonary aspiration

o   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