teaching of wound care to the patient/client or the patient’s/client’s family”. – Medicare Benefit Policy Manual 40.1.2.8 Wound assessment should be documented every visit to include the nature of drainage (color, odor, quantity, consistency) and condition/ appearance of the wound bed and surrounding skin. Wounds should be measured (length, width, and depth) weekly. 9. Ostomy Care “Ostomy care during the post-operative period and in the presence of associated complications where the need for skilled nursing care is clearly documented is a skilled nursing service. Teaching ostomy care remains skilled nursing care regardless of the presence of complications. The teaching services and the patient/client and/or caregiver responses must be documented”. – Medicare Benefit Policy Manual 40.1.2.9 10. Venipunctures Venipunctures are covered if ordered by a physician and/or non-physician practitioner and there is another skilled service being performed. It cannot stand alone as the qualifying skill. Services must be reasonable and necessary for the illness or injury, and the frequency of lab is: A. Consistent with accepted standards of medical practice B. Consistent with the nature of the treatment 11. Psychiatric Nursing “The evaluation, psychotherapy, and teaching needed by a patient/client suffering from a diagnosed psychiatric disorder that requires active treatment by a psychiatrically trained nurse and the costs of the psychiatric nurse’s services may be covered as a skilled nursing service. Psychiatrically trained nurses are nurses who have special training and/or experience beyond the standard curriculum required for a registered nurse. The services of the psychiatric nurse are to be provided under a plan of care established and reviewed by a physician. Services of a psychiatric nurse would not be considered reasonable and necessary to assess or monitor use of psychoactive drugs that are being used for nonpsychiatric diagnoses or to monitor the condition of a patient/client with a known psychiatric illness who is on treatment but is considered stable. A person on treatment would be considered stable if their symptoms were absent or minimal or if symptoms were present but were relatively stable and did not create a significant disruption in the patient’s/client’s normal living situation”. – Medicare Benefit Policy Manual 40.1.2.15 Medicare does not require a psychiatrically trained nurse to administer or assess psychotropic medications.
