I have a few questions around hospice/palliative care/comfort measures.

For Safe Use of Opioids (CMS 506) there is denominator exclusion of "Intervention Palliative or Hospice Care" and "Discharge Disposition of "Hospice Care Referral or admission."  

1. On the patient's Admission/Discharge/Transfer report, it shows the discharge disposition as "Home Care" and there is also a field for "Discharge Destination" that states "Home Health/Hospice."  Should the "discharge destination" be a field we map to for a "hospice" inclusion term?" We currently only map to discharge disposition so in this instance the discharge disposition would map to "Home", but if CDAC were to review our chart for validation purposes, they would see the documentation of "home health/hospice" in the discharge destination field.

2. In the Discharge order, there is also a field for "discharge destination" that includes option of "home health/hospice." Is this something we should map to? I think it comes from the same background location/code as #1 above.

3.  This question is for both Safe Use of Opioids and VTE-1, -2 measures. There is a "Service to Home Care" order on day of IP admission or day after.  There is a questionnaire within this order with a question "Agency Information" and the response is "Kathy Hospice." There is also a question of "Hospice Services Needed" and if this is answered 'yes' should we be mapping to the field if discrete to use as an inclusion of the value set for the denominator exclusion criteria?  

4. There is a flowsheet called "Initial Assessment" and a row of "Discharge Goals" with a response of "hospice".  If the "hospice" documentation is discrete to be map to that flowsheet row, should we be including this as a denominator exclusion?