Gtube

[MDSRN15]

Expert,

I have a med A resident with a NEW gtube placement, but was done in Barbados. He is 90 y/o, vacationing in his country, had CVA and needs gtube. Came back to US and used Med A in our facility. Is it ok to skill for gtube even if it was not performed here in US?

Thank you!

[MunoRN, RN]

I'm not sure why you think it wouldn't qualify for medicare or Medicaid coverage?

[Talino]

Expert,

I have a med A resident with a NEW gtube placement, but was done in Barbados. He is 90 y/o, vacationing in his country, had CVA and needs gtube. Came back to US and used Med A in our facility. Is it ok to skill for gtube even if it was not performed here in US?

Thank you!

A reasonable concern. CMS, however, states ...

20.1.1 - Three-Day Prior Hospitalization - Foreign Hospital

(Rev. 228, Issued: 10-13-16, Effective: 10-18-16, Implementation: 10-18-16)

A stay of 3 or more days in a hospital outside the United States may satisfy the prior inpatient stay requirement for post-hospital extended care services within the United States if the foreign hospital is qualified as an "emergency hospital" (see Pub 100-04, Medicare Claims Processing Manual, chapter 32, §§350ff. for a description of foreign and emergency services payable by Medicare.

Read the additional guideline pp 10-11 https://www.cms.gov/Regulations-and-Guidance/Guidance/Manuals/downloads/bp102c08.pdf