Barbara,
My "work around" this issue w/ Medicare is to simply not enter an ICD-9 code for their terminal illness, rather use their other non-hospice qualifying diagonses, i.e. HTN, DM, etc.
While perhaps technically incorrect, here is my viewpoint: I can talk about whatever I want behind closed doors w/ my patient, Medicare only needs to care about the diagnoses for which I am submitting claims. So I can document and code for the HTN, and discuss their cancer pain but simply not code for it. I would challenge Medicare to find out that I talked about their cancer pain, and if they are going to go after me.......fine, it's at least for a good cause.
