Chemotherapy

Talino · Sep 16, 2008

when given daily, yes. if less frequent than that, what services did the resident require/receive during the rest period between sessions?

three of the most critical nursing activities to support medicare coverage that meets the criteria for a "daily basis" requirement:

overall management and evaluation of an individual's care plan.
observation and assessment of the patient's changing condition.
patient education services

see attached highlighted text for details of above. doc'n is crucial.

Criteria For Skilled Services.pdf

Nascar nurse, ASN, RN · Sep 16, 2008

Talino, as you know always has the best sources, but my opinion...

I would take a common sense approach:, ie: If they are getting it 5x/wk, sicker than a dog, not eating, at real risk for losing significant weight loss, need pain management, etc - than I would document all that and cover them.

On the otherhand, we once had a "low dose, long term, weekly chemo resident" that had no ill effects at all, in fact enjoyed her "ride outside" once/wk and we did not skill her.

CapeCodMermaid, RN · Sep 16, 2008

This man gets chemo 1x/week. So far no ill effects but he has only recently returned to chemo. We'll skill him for a while and if he is fine, I guess that will be that.

edhcinc · Sep 17, 2008

You may also want to check that the chemotherapy is being billed by the provider using a HCPCS code that is excluded from MC PPS consolidated billing. Some more recent chemotherapeutic agents (or those deemed to be experimental) HAVE NOT YET BEEN APPROVED, and the facility can be billed by the provider if not SPECIFICALLY EXCLUDED by the HCPCS code.

See http://www.cms.hhs.gov/SNFPPS/05_ConsolidatedBilling.asp

for more information.

Unless the person is having side effects from the chemo, or has had bad side effects in the past, I would NOT cover. A person can always be placed BACK onto MC retroactively, but cannot be "cut" retroactively.

Good luck!