13. Skilled-need justification

This module maps to the four Medicare skilled-nursing categories. Document the one(s) that apply this visit in coverage language.

Observation and assessment

Assessing a device site, confirming patency and securement, recognizing occlusion, infection, dislodgement, infiltration, thrombosis, and embolic risk, and judging feeding or infusion tolerance require the knowledge and judgment of a licensed nurse. Device-complication surveillance is the core of observation and assessment for this domain.

Teaching and training

Teaching site care, dressing protection, flushing, complication recognition, what to do if a device is dislodged, and feeding or infusion administration — to patient and caregiver competence with return demonstration — is skilled teaching and training.

Management and evaluation of the plan of care

Evaluating whether the device is functioning and the site remains uncomplicated, and coordinating dressing-protocol changes, occlusion management, line changes, or removal when it is not, is skilled management and evaluation of the plan of care.

Skilled procedures

Sterile dressing changes, flushing and locking, port access and de-access, occlusion management, drain management, enteral-tube care and feeding, and home-infusion administration are skilled procedures — the defining skilled service of this domain.