Psychiatric and mental-health assessment and the response it drives qualify as skilled nursing under the Medicare coverage categories below. The note must connect skilled need to the diagnosis and the specific risk; the safety response to identified risk is itself skilled work.
Observation and assessment
The patient's mental-health status has a reasonable potential for change requiring skilled observation to identify the need to modify treatment or obtain additional care. Administering and interpreting validated screens, assessing and responding to risk, and distinguishing a primary psychiatric presentation from a medical or delirium cause require nursing judgment.
Teaching and training
Psychiatric-medication adherence, coping strategies, and crisis resources require skilled instruction with reinforcement to mastery.
Management and evaluation of the plan of care
When the patient's overall condition and the complexity of the unskilled services require a registered nurse to coordinate care and ensure safety given the mental-health condition, management and evaluation of the plan of care is itself a skilled service.
Skilled procedures
For example, administering and interpreting validated mental-health screening instruments where performed.
