Is this a skill?

Specialties MDS

Published

Specializes in Gerontology, Med surg, Home Health.

We have a 104 year old patient who was admitted s/p fall at home with C1 fx. She is done with rehab. Has NO pain. Has a surgically debrided bunion on her foot. Is a once a day dressing change enough to keep her on Med A at a skilled level.?

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At 104 yrs. old?? How much other care does she need?

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Specializes in ER CCU MICU SICU LTC/SNF.

If a recent procedure, probably for a few days (5-7) to observe for infection. Can be extended if healing is compromised by an existing vascular problem or DM.

http://www.cms.hhs.gov/manuals/Downloads/bp102c08.pdf p31 bullet#4

30.5 - Nonskilled Supportive or Personal Care Services

* Changes of dressings for uninfected post-operative or chronic conditions

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We have a 104 year old patient who was admitted s/p fall at home with C1 fx. She is done with rehab. Has NO pain. Has a surgically debrided bunion on her foot. Is a once a day dressing change enough to keep her on Med A at a skilled level.?

OT, but dont you just love those tough old New Englanders....lol

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Specializes in Gerontology, Med surg, Home Health.

Why would anyone do a bunionectomy on a 104 yr old? It is not infected and she's been with us for at least 21 days. She doesn't have diabetes but does have 104 blood vessels so I could argue she has compromised lower extremity circulation. Both the podiatrist who did the bunionectomy and the PCP say she HAS to stay at the nursing home and HAS to be skilled. Neither one of them probably knows as much about Medicare regs as we do. Thanks for your help.

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Specializes in LTC, Hospice, Case Management.
Why would anyone do a bunionectomy on a 104 yr old? It is not infected and she's been with us for at least 21 days. She doesn't have diabetes but does have 104 blood vessels so I could argue she has compromised lower extremity circulation. Both the podiatrist who did the bunionectomy and the PCP say she HAS to stay at the nursing home and HAS to be skilled. Neither one of them probably knows as much about Medicare regs as we do. Thanks for your help.

In my experience, it is very rare for nearly ANY Dr. to understand SNF medicare regs! Our medical director thinks he knows, but even he doesn't always "get it". Can't imagine a podiatrist telling us who to skill.

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According to the MDS bible.... if it is a surgical wounds (M4) it includes healing and nonhealing, open or closed surgical incisions, on any part of the body until it heals. So I would skill her... we all interpret things differently- just as long as you can stand up to a review and back it up.

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"Skilled" service for any surgical wound til healed??

  • Checking "surgical wound care" does put the person into a so-called "coverable" RUG. But that presumptive coverage is only "good" on a 5-day assessment.
  • Daily wound care must require the skills of a licensed nurse.
  • In-patient SNF care must be medically necessary.

Mental status, mobility, co-morbidities, environment, support network, etc. can all affect a coverage decision.

If you believe there are enough reasons and CAN back up your decision--document it in the record now. If you can't, good luck.

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