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

(Required for dates of service prior to January 1, 2023 only)

• 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

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