HOPE Guidance Manual v1.02, Item I0010

Timepoint(s) Item Completed

Admission (ADM)

Item-Specific Instructions

• The principal diagnosis is defined as the condition established after reviewing all available information

to be chiefly responsible for the patient’s admission.

• For hospice patients, this is the diagnosis that most contributes to the patient’s life expectancy of six

months or less if the illness runs its normal course.

• This item should be completed based on the patient’s principal diagnosis at the time of admission to

hospice.

• Review the clinical record for information regarding the principal diagnosis.

• Item completion must be based on what is indicated in the clinical record.

o Do not use sources external to the clinical record.

• Review all response choices before making a selection.

• Code 99, None of the above, if the patient’s principal diagnosis is a disease or condition not listed.

Coding Tips

• Use Code 01. for all types of cancer, e.g., skin and blood cancers.

• Code 02 includes all types of dementia, e.g., Lewy body dementia and Pick’s disease.

• Note that two principal diagnosis response codes are related to cardiac conditions. One is for

cardiovascular conditions excluding heart failure (06) and the other is specific to heart failure (07).

Comorbidities and Coexisting Conditions

• Review the medical record for comorbidities and/or coexisting

conditions at the time of admission to hospice.

• Check all comorbid and/or coexisting diseases or medical

conditions that are addressed in the plan of care or that have

the potential to impact the plan of care.

• Do not include the principal diagnosis, except if the patient

has a secondary cancer.

Example

During the admission assessment, the patient explains that she has a history of diabetes which is well controlled

and also had breast cancer 25 years ago. She was treated for the breast cancer at that time and has scarring from

a left breast mastectomy. At the time of the hospice admission the terminal diagnosis is stage four colon cancer.

Coding: I 0010. Principal Diagnosis would be coded 01, Cancer, and I0100. Cancer, and I2900. Diabetes

Mellitus (DM) would be checked for Comorbidities and Coexisting Conditions.

Rationale: Based upon the clinician’s assessment and patient report, the nurse records Cancer for both

the Principal Diagnosis and the Comorbidities and Coexisting Conditions category.

DEFINITION

COMORBIDITIES

Refers to diseases or medical

conditions that occur

simultaneously with the principal

diagnosis.