Navigating the Nutrition Policies - JA DME
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
(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
Last Updated Wed, 30 Nov 2022 14:39:48 +0000