B. Oral medication administration, administering eye drops or topicals do not require the skills of a nurse. Skilled teaching may be appropriate in some cases to ensure proper administration by the patient/client or the caregiver. 5. Tube Feedings “Nasogastric tube, and per cutaneous tube feedings (including gastrostomy and jejunostomy tubes), and replacement, adjustment, stabilization. and suctioning of the tubes are skilled nursing services, and if the feedings are required to treat the patient’s/client’s illness or injury, the feedings and replacement or adjustment of the tubes would be covered as skilled nursing services”. – Medicare Benefit Policy Manual 40.1.2.5 6. Nasopharyngeal and Tracheostomy Aspiration “Nasopharyngeal and tracheostomy aspiration are skilled nursing services and, if required to treat the patient’s/client’s illness or injury, would be covered as skilled nursing services”. – Medicare Benefit Policy Manual 40.1.2.6 7. Catheters “Insertion and sterile irrigation and replacement of catheters, care of a suprapubic catheter, and in selected patients/clients, urethral catheters, are considered to be skilled nursing services. Where the catheter is necessitated by a permanent or temporary loss of bladder control, skilled nursing services that are provided at a frequency appropriate to the type of catheter in use would be considered reasonable and necessary. Absent complications, Foley catheters generally require skilled care once approximately every 30 days and silicone catheters generally require skilled care once every 60-90 days and this frequency of service would be considered reasonable and necessary. However, where there are complications that require more frequent skilled care related to the catheter, such care would, with adequate documentation, be covered”. – Medicare Benefit Policy Manual 40.1.2.7 8. Wound Care “Care of wounds, (including, but not limited to, ulcers, burns, pressure sores, open surgical sites, fistulas, tube sites, and tumor erosion sites) when the skills of a licensed nurse are needed to provide safely and effectively the services necessary to treat the illness or injury, is considered to be a skilled nursing service. For skilled nursing care to be reasonable and necessary to treat a wound, the size, depth, nature of drainage (color, odor, consistency, and quantity), and condition and appearance of the skin surrounding the wound must be documented in the clinical findings so that an assessment of the need for skilled nursing care can be made. Moreover, the plan of care must contain the specific instructions for the treatment of the wound. NOTE: This section relates to the direct, hands on skilled nursing care provided to patients/clients with wounds, including any necessary dressing changes on those wounds. While a wound might not require this skilled nursing care, the wound may still require skilled monitoring for signs and symptoms of infection or complication (See §40.1.2.1) or skilled
