skilling after a G-tube

  1. The question for the day, lol. I have a resident that came back in after a 90 day hospital stay, has been in and about about a dozen times. He has had a PEG for a while, not sure how long. He was medicaid on his last admission. His HIQA shows 10 days left. Since I've been back in the MDS world I've heard that having 26% or more of your caloric intake from a G tube doesn't automatically disqualify you from recieveing another 100 days of Medicare coverage for another skilled need anymore. Is this true?

    I've got a call in to our medicare guru, but haven't heard back from her yet. And if it is still like it was 5 years ago (that G tube residents can never be skilled medicare again) how come this residents HIQA is showing 10 days? Any ideas?

    Oh, BTW, this resident does have a new skilled need, unrelated to the tube feeding. He is going to be recievieng IV ABTs x 30 days.
  2. Visit crissrn27 profile page

    About crissrn27

    Joined: Feb '07; Posts: 1,020; Likes: 341
    newborn nursery
    Specialty: 8 year(s) of experience in nursery, L and D


  3. by   edhcinc
    hi--please see this thread--info and references.
  4. by   crissrn27
    Hi, thanks! Even though this was almost as confusioning! The main thing is that it remains if you continue to remain in SNF bed and recieve a skilled service with no 60 day spell of wellness, you don't get a new medicare period. Including 26% of calories and 501cc fluid daily or up..............right?

    This is what I'm taking from the previous thread, and what I got from reading the new regs that came out in 2006. Didn't think things had changed so dramatically in the 4-5 years I've been out of LTC!
  5. by   edhcinc

    re: "...if you continue to remain in snf bed and recieve a (daily) skilled service with no 60 day spell of wellness, you don't get a new medicare period"

    • correct
    if a person has no daily skilled service for 59 days, then

    • goes to the hospital er and receives a blood transfusion and returns, or
    • gets im antibiotics for 3 days then switches to p.o., or
    • requires q 6 hr catheterization for 3 days (bladder retention due to a drug)

    you have to re-start the count all over again.

    such fun...

Must Read Topics