Documentation
What is Bolus, Gravity or continuous infusion pump?
TPN - This criteria is required to demonstrate LON for TPN
What is long/indefinite duration of need?
TPN - By using a Gastric Emptying test result you can confirm this diagnosis
What is Dysmotility?
TPN - For the non-functioning small bowel diagnosis a statement regarding this must be in the MD progress note
What is a failed tube feeding trails, attempts made to place a tube or intolerant to oral intake?
ENT - This is the enteral method of administration used for a J-tube.
What is a pump?
ENT - Any time a patient is prescribed a specialty formula this is documentation Medicare requires
What is formula justification?
ENT - A patient with Medicare Primary Insurance could possibly have coverage of Enteral nutritional therapy under what part of Medicare
What is Part B?
TPN - Elevated Amylase & Lipase are lab tests that can indicate this diagnosis?
What is Pancreatitis?
TPN - Wound care notes can be used to assist in qualifying this diagnosis?
What is a GI Tract Fistula/ Enterocutaneous Fistula?
ENT/TPN - This is a measurable metric that can indicate malnutrition?
What is weight loss, albumin or pre-albumin?
ENT - This document lists the reasons a patient may not qualify for nutrition therapy under Medicare part B guidelines
What is the ABN?
TPN - This is a diagnosis that requires bowel rest/minimal PO for a long/indefinite timeframe documented
What is Pancreatitis, Regional Enteritis or Enterocutaneous Fistula?
ENT - A stroke patient sees a speech therapist and has this test done to diagnose dysphagia
What is a swallow evaluation or barium swallow study?
TPN - Prokinetic medications must be trialed or documented why it cannot be used for this diagnosis?
What is Dysmotility?
TPN - This is an objective test that can be used to confirm Pancreatitis?
What is a CT scan?
ENT - A final note by Medicare reviewer for any Medicare patient can only be completed once this is received
What is a “Medicare valid” Rx?
ENT - How many days/weeks or months does Medicare cover, of a patient’s enteral nutrition therapy at a time
What is one month of supplies/formula?
TPN - A Small Bowel follow through test can be used to confirm this diagnosis
What is Short Bowel Syndrome or Dysmotility?
TPN - This statement can be used in lieu of objective testing “diarrhea or high output ostomy associated with weight loss or malnutrition/dehydration/electrolyte imbalance” for this diagnosis?
What is Short Bowel Syndrome/Malabsorption?
TPN - This is the name of a Prokinetic medication you would look for in the patient chart with dysmotility?
What is Reglan or erythromycin?