Nursing skilling

[TigerxLiLy]

If you have a LTC pt that comes back from hosp after a qualifying 3 day hosp stay (at a psych ward) on medicare A-- they go thru therapy for 4 weeks and meet their prior lvl of independance and have to be dropped from therapy. Their DX was depression and UTI, psych meds were not changed since hospitalization 4weeks ago with the wax and waning mood due to dementia.

Do you skill them under nursing? Is it really skilled nursing if they were going to be under 24/7 nursing care anyway?

[Talino]

http://www.cms.gov/Regulations-and-Guidance/Guidance/Manuals/downloads/bp102c08.pdf p25

30.2.3.2 - Observation and Assessment of Patient's Condition

Observation and assessment are skilled services when the likelihood of change in a

patient's condition requires skilled nursing...

Skilled observation and assessment may also be required for patients whose primary condition and needs are psychiatric in nature or for patients who, in addition to their physical problems, have a secondary psychiatric diagnosis. These patients may exhibit acute psychological symptoms such as depression, anxiety or agitation, which require skilled observation and assessment such as observing for indications of suicidal or hostile behavior. However, these conditions often require considerably more specialized, sophisticated nursing techniques and physician attention than is available in most participating SNFs. (SNFs that are primarily engaged in treating psychiatric disorders are precluded by law from articipating in Medicare.) Therefore, these cases must be carefully documented.