How to document SN visit frequency

[TINKER968]

This is not exactly an Oasis question, but I was hoping someone could help me with the correct way to document skilled nurse frequency. Our Biller tells us that the documentation is changing for the weeks with one to 3 days left over at the end of the calendar. For example I was taught to document 0D1 for 1 day left over with no visits . 1D1 for 1 day left with a visit on that day. 1D3 for one visit with 3 days in that last week. I am completely unsure of myself now. I would appreciate any explanation of the correct way to document the frequency.

[CardioTrans, BSN, RN]

We never use 0 freq. If we have a cert period beginning on a weekend, and the first visit that we are doing is the next week.... we write something to the effect of 1w_, freq to begin week of ______.

[TINKER968]

I have been asking other nurses in my area and evidently the 0 is being used by most of the agencies. I am going with the flow and see what happens. I audit frequently to make sure I don't make a mistake since it is so easy using the 0's.

[NRSKarenRN, BSN, RN]

Came across these state surveyor guidelines: (Pg.38)

http://cms.hhs.gov/manuals/Downloads/som107ap_b_hha.pdf

G158

Care follows a written plan of care established and periodically reviewed by a doctor of medicine, osteopathy, or podiatric medicine.

Interpretive Guidelines §484.18

It is CMS’ policy to require that the HHA must have a plan of care for each patient, regardless of the patient’s Medicare status or that nurse practice acts do not specifically require a physician’s order.

The CoPs do not require a physician’s order for services furnished by the HHA that are not related to the patient’s illness, injury, or treatment of the patient’s medical, nursing, or social needs.

Medical orders may authorize a specific range in the frequency of visits for each service (i.e., 2-4 visits per week) to ensure that the most appropriate level of service is provided to the patient. However, ranges the include "0" as a frequency are not allowed, because "0" is not a frequency.

The regulation requires the HHA to alert the physician to any changes that suggest a need to alter the plan of care. If the HHA provides fewer visits than the physician orders, it has altered the plan of care and the physician must be notified The HHA must maintain documentation in the clinical record indicating that the physician was notified and is aware of the missed visit.

[fizzgigger]

So if I have a schedule that looks like this: 0w1, 2w8, 0w1, it would be written like this: effective 03.27.2011 2w8.

In this instance the Recert is on April 23th, and no visits are scheduled the week of April 24 until April 29 which would be in the next certification period of 04.28.11 tp 6.26.11 (assuming they recertify). How would you write that remaining 0w1?

[KateRN1]

If the last day of the episode is 4/27, then you can do the recert visit on 4/23 (Saturday) and still be within the 2W8 frequency, but if you are planning to do the recert visit 4/24-4/27, then it should be 2W8, 1W1 to accomodate for the recert visit which must occur between days 55-60. If you are not planning to recert but will discharge at some point prior to 4/24, then you do not need to account for the following week. I would recommend 2W8, 1W1 to cover all bases, because who really wants to go out to do a recert visit on a Saturday?

[BrookeeLou_RN]

Frequency sometimes depends on agency..worked for one who insisted if 4 days in first week this had to be written separate, so there never was any 1 wk9 unless case was opened on last day of their week and only one visit.. I've done this for 20 yrs and I never did get or understand their thinking and they would use zeros like 1 da1 and 0day3 then 1wk8.. and again if week did not end on right day you did funny things again.. Also one place merely wrote one visit days 56 to 60 for rct or DC on the orders.

So OP might want to check with her agency to make sure she is doing it right for them.