Navigating the Nutrition Policies

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
  • 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

DME Information Form (DIF) Reminders

  • New Initial DIF required when:
    • Break in need (Enteral Nutrition and pump, Parenteral Nutrition)
    • Formula with different code (Enteral Nutrition)
    • Change from syringe/gravity to pump (Enteral Nutrition pump)
  • Revised DIF required when:
    • Change in calories (Enteral Nutrition)
    • Change in number of days per week (Enteral and Parenteral Nutrition)
    • Change in method of administration (Enteral Nutrition)
    • Change from tube to oral feeding (Enteral Nutrition)
    • HCPCS for current nutrient changes (Enteral Nutrition)
    • Nutrients with a different code (Parenteral Nutrition)
      • No revised DIF needed if within range of code
      • For example: B4197 (74-100 grams of protein)
      • Original order is for 80 grams of protein and subsequent order increased to 95 grams of protein, a revised DIF is not needed.
    • Extend LON prescribed when previous LON has expired

Medical records must clearly document

  • Permanent condition
  • Coverage criteria
  • Length of need

Resources

 

Last Updated Wed, 15 Aug 2018 11:51:14 +0000