Navigating the Nutrition Policies - JA DME

Understanding what is required before dispensing equipment and supplies is vital to having a successful claim outcome, including reimbursement. The Enteral and Parenteral Nutrition policies are no exception. This article is intended to provide assistance on billing for nutrition; however it is only a summary of some areas. It is important to read and understand the entire Enteral and Parenteral Local Coverage Determination and Policy Article.

Enteral Nutrition Order Reminders

• Start date only required if physician is ordering to start therapy at a later time
• Dosage/concentration: Formula 1.2, Formula 1.5, calories or cans per day, etc.
• Administration
  • Route: G-tube, J-tube, NG-tube
  • Method: syringe, gravity, pump, elastomeric control
• Frequency of use: daily, mls/hour, etc.
• Duration of infusion: over 12 hours, over 24 hours, etc.
• Quantity to be dispensed: two week supply, 30 day supply
  • Able to dispense partial shipments
• Number of refills: Not length of need (LON)

Parenteral Nutrition Order Reminders

• Start date only required if physician is ordering to start therapy at a later time
• Dosage/concentration: amino acids 915 ml/day 10% concentration
• Frequency of use: daily, alternating days
• Duration of infusion: over 12 hours, over 24 hours, etc.
• Quantity to be dispensed: one week supply, 14 day supply
  • Able to dispense partial shipments
• Number of refills: Not LON

Medical records must clearly document

• Permanent condition
• Coverage criteria
• Length of need

Resources

• Local Coverage Determinations and Policy Articles
• Documentation Checklists
• Clinician Resource Letters