Re: Tube feed old vs. new

[RRS2000]

Given the circumstances described in your e-mails, this resident can be skilled for the entire 100-day benefit period for the tube feeding as long as all of the other technical, eligibility, and level of care criteria are met.  There is no distinction between "old" and "new" in this context.  If she had the 60-day break, etc., then she can be covered for the tube feeding since she received treatment related to the tube feeding while she was in the hospital (during the 3-day qualifying hospital stay).

Rena

Rena R. Shephard, MHA, RN, FACDONA, RAC-C
Chair, American Association of Nurse Assessment Coordinators
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Subj: RE: Tube feed old vs. new
Date: 4/5/04 7:46:57 AM Pacific Standard Time
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She was admitted from the hospital, prior to that from home.  She has been here in the past for the tube, but home from here, then back in for the current admission (we are a Hospital-based short term unit; nobody "lives here").  Prior admission for the tube probably used about 14 days.  She has been out of skilled for a while.  At this admission she is eligible for all 100 days of skilled care.  She is definitley receiving the calorie and fluid intake; the tube is her primary source; PO is for pleasure foods only and Specch is tapering that because she is not demo-ing safe swallow.  All sounds good for skilled criteria, but her baseline is home with daughter administering feeds. It is not "new" in that sense; they have been educated and can provide care at home; she doesn't need skilled care for that reason.  I don't think ther calories alone are enough to skill her given the total picture...or are they?  I'm thinking that because of the leaking and new tube placement that we can keep her for monitoring, but for how long?
 
thanks for your input.  Sorry to bombard you with all these details!
Monica

-----Original Message-----
From: Karen Berry [mailto:[EMAIL PROTECTED]
Sent: Monday, April 05, 2004 10:33 AM
To: [EMAIL PROTECTED]
Subject: Tube feed old vs. new


Was this resident in your facility prior to the recent hospitalization? Has she used Medicare time with the old tube, and if so, how many? Has she been receiving the amount of calories and cc's to meet the skilled criteria under Medicare Part A? All these need to be taken into consideration, as dependence on the tube feeding is a skilled service and if it has not been interrupted there is no new benefit period available under Medicare Part A, even with a new diagnosis.

Subj: Tube feed-old or new?�
Date: 4/5/04 8:13:11 AM Pacific Standard Time
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Can I continue to skill under Med A a resident for a peg tube under the following circumstances: Peg tube is old; had for years.� Now in for hip fracture, skilled for� PTOT.� Peg tube leaking during stay.� Replaced several times and still leaking.� Finally went to OR for entirely new peg.� Has been tolerating feeding without leakage for the past few days.� Is the Peg tube/feeding a skillable service?� Is it considered old or new?� And if I can do this, for how long?� Thanks in advance.� Please email me responses at [EMAIL PROTECTED] (I don't always get all the group responses through the cmdg address for some reason?!)Thanks,
Monica