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skilling after a G-tube



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Jul 04, 2009 10:51 AM

skilling after a G-tube


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.


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3 Comments
No. 1
from edhcinc
Old Jul 06, 2009, 08:09 PM

Default Re: skilling after a G-tube
hi--please see this thread--info and references.


http://allnurses.com/mds-coordinator...-a-360503.html
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No. 2
from crissrn27
Old Jul 06, 2009, 08:21 PM

Default Re: skilling after a G-tube
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!
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No. 3
from edhcinc
Old Jul 06, 2009, 08:36 PM

Default Re: skilling after a G-tube
HI!
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...
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