Hospice care providers and medical coders must navigate ICD-10 codes to document diagnoses accurately, bill properly, and stay compliant. This 2025 guide explains ICD-10 hospice codes in a simple, practical way. You’ll learn how to use primary and secondary codes, what documents you need, and how to avoid common coding mistakes.
Whether you are a hospice clinician, medical coder, billing specialist, or compliance officer, this guide gives you practical tools to improve coding accuracy and simplify hospice claims. It also covers common hospice diagnoses—such as dementia, Alzheimer’s, heart failure, and kidney disease—and shows how to use the correct ICD-10 codes for home health and hospice care.
Stay prepared in 2025 by learning the key ICD-10 hospice codes that support quality care and compliance.
What are ICD-10 Hospice Codes?
Patients undergoing hospice or palliative care might have their medical issues described using ICD-10 hospice codes. These codes, derived from the International Classification of Diseases, 10th Revision (ICD-10), are crucial for accurate invoicing, care planning, and documentation.
Purpose of ICD-10 in Hospice Care
In hospice, ICD-10 codes serve three key purposes:
- Billing: Medicare and other payers require accurate diagnosis codes to approve and pay for hospice services. Accurate coding also reduces hospice claim denials and improves payment turnaround.
- Compliance: Using the correct codes helps providers meet CMS and payer regulations. Incorrect coding can lead to audits or denied claims.
- Care Planning: Codes identify the patient’s terminal condition and related health issues. This information helps the hospice team create a care plan that meets the patient’s needs.
How Hospice Coding Differs from Hospital or Clinic Coding
Conditions that are anticipated to cause the patient’s death within six months or less are the subject of hospice coding. Hospitals and clinics, however, frequently code for acute conditions, wounds, or symptoms that are being treated temporarily.
Other key differences:
- Hospice coding must reflect the declining trajectory of the disease.
- Coders must often choose from a smaller set of appropriate codes, as some ICD-10 codes (e.g., symptoms, injuries, or vague conditions) are not allowed as primary hospice diagnoses.
- Hospice also emphasizes related conditions, which may need to be reported even if they aren’t terminal illnesses.
Primary vs. Secondary Hospice Codes
- The primary hospice code refers to the principal diagnosis—the main condition causing the terminal illness. For example, if a patient is dying from advanced heart failure, this would be coded as the primary diagnosis.
- Secondary codes describe related or contributing conditions. These can include diabetes, pressure ulcers, or chronic kidney disease. These conditions may affect the patient’s care, but are not the leading cause of death.
It is crucial to select a valid primary hospice diagnosis that meets CMS guidelines and aligns with terminal illness ICD-10 codes that Medicare recognizes for hospice care eligibility. Secondary codes help paint a complete picture of the patient’s health status.
Commonly Used Hospice ICD-10 Codes (2021 Update)
Hospice providers appropriately record patients’ terminal diagnoses and conditions using specified ICD-10 codes. This ensures appropriate reimbursement and compliance. Primary Hospice Diagnoses and Secondary/Other Conditions comprise the following updated list of frequently used hospice codes for 2025.
| Primary Hospice Diagnoses | ICD-10 Code | Secondary/Other Conditions | ICD-10 Code |
| Dementia (including Alzheimer’s disease) | G30.9 | Chronic kidney disease stage 4 | N18.4 |
| Heart Failure, unspecified | I50.9 | Pressure Ulcer, Unspecified Location | L89.90 |
| Chronic Obstructive Pulmonary Disease | J44.9 | Diabetes Mellitus Type 2 with complications | E11.9 |
| End-Stage Renal Disease | N18.6 | Major Depressive Disorder | F33.1 |
| Metastatic Cancer | C79.9 | Congestive Heart Failure | I50.22 |
| Stroke (Cerebral Infarction) | I63.9 | Anemia, unspecified | D64.9 |
| Liver Cirrhosis | K74.60 | Chronic Pain Syndrome | G89.29 |
These codes are commonly reviewed during Medicare hospice eligibility audits and must align with CMS-approved terminal diagnoses.
Alzheimer’s Disease and Dementia Codes
Hospice patients usually have dementia or Alzheimer’s disease as their primary diagnosis. These ICD-10 codes help specify the type and symptoms supporting thorough documentation and billing.
- G30.9 – Unspecified Alzheimer’s Disease
Use this code when the patient has Alzheimer’s disease, but the specific type or stage is not documented. - G31.83 – Dementia with Lewy Bodies
This code applies to patients diagnosed with dementia characterized by Lewy bodies, which can cause cognitive decline and movement issues. - F01.51 – Vascular Dementia with Behavioral Disturbance
Select this code for patients with vascular dementia who also show behavioral symptoms such as agitation or aggression.
Each code helps hospice providers clarify the patient’s condition and tailor care plans accordingly.
Heart Failure and Cardiac Conditions
Heart failure and related cardiac conditions are common primary diagnoses in hospice care. Using the correct ICD-10 codes helps capture the severity and specifics of the patient’s heart disease.
- I50.42 – Chronic Combined Systolic and Diastolic Heart Failure
This code covers patients with long-term heart failure affecting both the heart’s pumping (systolic) and filling (diastolic) functions. - I25.5 – Ischemic Cardiomyopathy
Use this code when the heart muscle weakens due to reduced blood flow from coronary artery disease. - I25.10 – Atherosclerotic Heart Disease Without Angina
This code applies to patients with hardened arteries but no chest pain symptoms (angina).
Accurate coding of these conditions helps hospice teams provide focused care and ensures proper billing.
Kidney and Liver Disease Codes
Chronic kidney and liver diseases often complicate hospice care. These ICD-10 codes help specify the stage and severity, which is vital for correct documentation and care planning.
- N18.3 – Chronic Kidney Disease, Stage 3
This code indicates moderate kidney damage, with a mild decrease in kidney function. - N18.4 – Chronic Kidney Disease, Stage 4
Use this code for severe kidney damage, just before kidney failure. - K72.90 – Hepatic Failure, Unspecified
This code applies when the patient has liver failure, but the type or cause is not clearly documented. - K74.60 – Unspecified Cirrhosis of Liver
Use this code for patients with cirrhosis when the specific type of cirrhosis isn’t detailed.
Accurately coding these conditions helps hospice teams understand patient needs and supports appropriate reimbursement.
Neurological Conditions
Neurological disorders often affect hospice patients and influence their care needs. Using the correct ICD-10 codes helps accurately describe the patient’s condition.
- G93.40 – Encephalopathy, Unspecified
Use this code for brain dysfunction that doesn’t have a specified cause or type. - I69.359 – Hemiplegia Post-Cerebral Infarction
This code applies to patients who have paralysis on one side of the body following a stroke. - G31.1 – Senile Degeneration of the Brain
Use this code for age-related decline in brain function that affects memory and cognition.
Precise coding of neurological conditions helps hospice providers plan care and communicate patient status clearly.
Pulmonary and Respiratory Conditions
Respiratory issues are common in hospice patients and often contribute to their overall health decline. Compliant coding helps capture the severity and cause of these conditions.
- J69.0 – Pneumonitis Due to Inhalation of Food or Vomit
Use this code when the patient develops lung inflammation from accidentally inhaling food or vomit. - I50.9 – Heart Failure, Unspecified
While primarily a cardiac code, heart failure often leads to respiratory symptoms like shortness of breath and fluid buildup in the lungs. - R60.0 – Localized Edema
This code applies when swelling occurs in a specific body part, often related to heart or lung conditions. - Z99.81 – Dependence on Supplemental Oxygen
The correct ICD-10 code for dependence on oxygen is Z99.81 (not 299.81, an ICD-9 code). Use this code to indicate a patient requires continuous oxygen support.
Proper use of these codes supports clear communication and ensures hospice care meets patient needs.
Other Common Hospice Diagnoses
Hospice patients often face multiple health challenges beyond their primary diagnosis. These additional conditions affect care plans and must be coded accurately.
- E43 – Severe Protein-Calorie Malnutrition
Use this code when the patient experiences significant weight loss and muscle wasting due to inadequate nutrition. - R53.82 – Chronic Fatigue
This code applies to patients with persistent and severe tiredness that does not improve with rest. - R63.0 – Anorexia
Use this code when the patient loses appetite, which is common in advanced illness. - A41.9 – Sepsis, Unspecified Organism
This code covers cases of sepsis (a severe infection) when the exact cause is not identified.
Accurate coding ensures hospice teams can address all aspects of patient care.
Primary vs. Secondary Hospice ICD-10 Codes
Understanding the difference between primary and secondary ICD-10 codes is crucial for accurate documentation and billing in hospice coding.
Primary Codes
The major hospice code indicates the primary ailment that prompted the patient to be admitted to hospice care. Usually, this diagnosis is considered terminal and results in death within six months. End-stage heart failure or advanced Alzheimer’s disease, for instance, would be included as primary codes.
Secondary Codes
Although not the primary cause of hospice admission, secondary codes represent co-morbidities or associated diseases that impact the patient’s general health and care requirements. Diabetes, pressure ulcers, and chronic renal disease are a few examples. Reporting these codes contributes to a comprehensive view of the patient’s health.
CMS Rules on Sequencing Primary vs. Secondary Codes
The Centers for Medicare & Medicaid Services (CMS) requires that hospice providers:
- Report the primary terminal diagnosis as the principal diagnosis.
- List secondary diagnoses that impact the care plan or symptom management.
- Avoid coding symptoms or conditions that do not reflect the patient’s terminal illness as primary.
Proper sequencing ensures claims are processed smoothly and reduces the risk of audits or denials.
Coding Guidelines for Hospice Care
Accurate coding in hospice care is essential to ensuring compliance with CMS and Medicare rules, supporting patient care, and securing proper reimbursement. Follow these guidelines closely.
CMS & Medicare Hospice Coding Compliance
CMS requires hospice providers to report ICD-10 codes that clearly reflect the patient’s terminal condition. Coding must support the prognosis of six months or less of life expectancy if the disease follows its usual course. Failure to comply can result in claim denials or audits.
Physician Documentation Requirements
Physician documentation must include:
- A terminal prognosis that states the patient is expected to live six months or less.
- Detailed information on the primary diagnosis.
- Relevant co-morbidities impacting care.
Clear and timely documentation supports accurate coding and compliance.
When Not to Use Unspecified Codes
Avoid using unspecified ICD-10 codes whenever possible. These vague codes can raise red flags during audits and may delay claim approvals. Instead, select the most specific code matching the patient’s condition and clinical documentation.
Hospice vs. Home Health ICD-10 Differences
Hospice coding emphasizes terminal diagnoses, prognosis, and symptom management. Home health coding, by contrast, focuses on treating acute or chronic conditions to improve or stabilize patients.
Understanding these differences helps providers choose the correct codes for the appropriate setting.
Frequently Coded Hospice Diagnoses Explained
Hospice treatment and billing are guided by common diagnoses that coders and providers frequently encounter. Knowing when and how to apply these codes is essential for accuracy and compliance. Below, we describe two of the most commonly coded hospice conditions.
Alzheimer’s & Dementia in Hospice Care
Dementia, including Alzheimer’s disease, qualifies as a primary hospice diagnosis when the patient’s cognitive decline is severe and terminal. The condition must be advanced enough to meet the six-month life expectancy guideline. Hospice teams should carefully document functional impairments and complications related to dementia.
Distinguishing Between Types of Dementia Codes
It’s crucial to select the correct dementia code based on clinical documentation:
- G30.9 for unspecified Alzheimer’s disease
- G31.83 for dementia with Lewy bodies
- F01.51 for vascular dementia with behavioral disturbance
Each type has unique clinical features and care implications. Accurate coding helps tailor hospice services and supports regulatory compliance.
Heart Failure and Cardiac Conditions
Chronic combined systolic and diastolic heart failure (I50.42) is a common reason for hospice admission because it represents advanced heart failure that significantly limits life expectancy and quality of life. These patients often have frequent hospitalizations and symptoms refractory to treatment.
Documentation Requirements for Cardiac Hospice Coding
Accurate coding requires detailed physician documentation, including:
- Confirmation of the type and stage of heart failure
- Symptoms such as shortness of breath, edema, or fatigue
- Evidence of the terminal nature of the disease and prognosis
- Relevant co-morbidities impacting care
Proper documentation ensures the correct use of ICD-10 codes and supports hospice eligibility.
CKD and Renal Failure in Hospice
Standard Progression → Hospice Admission
Although chronic kidney disease (CKD) usually advances slowly, it can eventually develop to end-stage renal disease (ESRD), which necessitates hospice care when the patient’s general health deteriorates and dialysis is no longer an option. Typically, when renal failure adds to a fatal prognosis, hospice admission occurs.
N18.3 vs. N18.4 vs. N18.6
- N18.3 – CKD Stage 3 (moderate damage)
- N18.4 –CKD Stage 4 (severe damage, near kidney failure)
- N18.6 – End-Stage Renal Disease (ESRD)
Choosing the correct stage based on clinical documentation is critical to reflect the patient’s condition accurately. ESRD patients often qualify for hospice when kidney function declines without dialysis or transplant options.
Malnutrition and Cachexia
Role of E43 and R64 in End-Stage Coding
- E43 — Severe Protein-Calorie Malnutrition
- R64 — Cachexia (wasting syndrome)
Both codes describe critical nutritional issues common in end-stage illness. Cachexia involves muscle wasting and weight loss despite adequate nutrition, while severe malnutrition reflects inadequate intake or absorption.
Documentation Guidelines
Physician notes should clearly document the presence, severity, and cause of malnutrition or cachexia. Nutritional assessments, weight loss history, and related symptoms strengthen coding accuracy and justify hospice eligibility.
ICD-10 Hospice Codes vs. Palliative Care Codes
Hospice and palliative care focus on improving the quality of life for seriously ill patients, but they differ in coding, usage, and billing.
Key Differences in Usage
- Hospice Codes
Hospice coding centers on terminal illnesses with a prognosis of six months or less if the disease runs its normal course. Codes primarily reflect the primary terminal diagnosis and relevant co-morbidities to support eligibility and care planning. - Palliative Care Codes
Palliative care can begin at any stage of a serious illness, even alongside curative treatments. ICD-10 codes often reflect chronic or acute conditions actively managed to relieve symptoms, but without the strict terminal prognosis requirement.
Key Differences in Billing
- Hospice Billing
Hospice services are usually billed at a per diem (daily) rate, covering all care related to the terminal condition. Accurate primary diagnosis coding is essential for Medicare and other payers to authorize hospice benefits. - Palliative Care Billing
Palliative care is billed under standard fee-for-service or bundled payment models, often linked to specific treatments or visits. The diagnosis codes reflect ongoing management rather than a terminal prognosis.
Understanding these distinctions helps providers use ICD-10 codes appropriately and optimize reimbursement in both care settings.
ICD-10 vs. ICD-11 for Hospice Care
The World Health Organization (WHO) has released ICD-11, the latest version of the International Classification of Diseases, which will eventually replace ICD-10. Here’s what hospice providers and coders should know about this upcoming update.
What to Expect in the ICD-11 Update
- Improved Specificity: ICD-11 offers more detailed and precise disease codes, including those familiar in hospice care. This means better descriptions of terminal conditions and related symptoms.
- Digital-Friendly Design: ICD-11 is designed for modern health IT systems, making it easier to integrate it into electronic health records (EHRs) and billing software.
- New Coding Structure: The coding format and organization have changed significantly, requiring training and updates to hospice coding protocols.
- Transition Timeline: While WHO has approved ICD-11, many countries—including the U.S.—are still in the planning or early implementation stages. Transitioning from ICD-10 to ICD-11 is expected to be gradual, with a phased rollout over several years.
- Impact on Hospice Care: Providers should prepare for more accurate coding options, which could improve patient data tracking and reimbursement but also require updates in documentation and coder education.
Hospice teams should stay informed on ICD-11 developments and plan for training and system upgrades to ensure a smooth transition when the update takes effect.
Conclusion
ICD-10 hospice codes are more than just billing tools; they are essential in patient care, compliance, and reimbursement. By choosing precise primary and secondary diagnoses, hospice providers can effectively communicate a patient’s terminal condition, facilitate care planning, and adhere to Medicare and CMS regulations.
Keeping up with the most hospice codes reduces the chance of claim denials and audits, regardless of your role as a medical coder, hospice nurse, doctor, or billing specialist. Correct documentation, sequencing, and application of these rules guarantees that your team maintains compliance while delivering the highest quality of care.
Use this guideline as a daily reference in your coding and documentation process. With correct coding, your hospice organization can deliver compassionate care while meeting regulatory requirements and securing appropriate reimbursement.
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Let us handle the complexities of ICD-10 hospice codes so you can focus on what matters most: patient care.
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