LIVER DISEASE

The patient has:

• Prothrombin time (PT) more than 5 seconds over control, or International Normalized Ratio (INR) >1.5
• Serum albumin <2.5 gm/dl and

And one or more of the following conditions:

• Ascities, refractory to treatment or patient non-compliant
• Spontaneous bacterial peritonitis
• Hepatorenal syndrome; elevated creatinine and BUN; oliguria {< 400 ml/day}; urine sodium concentration < 10 mEq/l; cirrhosis and ascites
• Hepatic encephalopathy, refractory to treatment or patient non-compliant
• Recurrent variceal bleeding, despite intensive therapy

Supporting documentation:

• Progressive malnutrition
• Muscle wasting with reduced strength and endurance
• Continued active alcoholism (>80 gm ethanol/day)
• Hepatocellular carcinoma
• HbsAg (Hepatitis B) positivity

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.