This module maps to the four Medicare skilled-nursing categories. Document the one(s) that apply this visit in coverage language.
Observation and assessment
Screening the swallow, recognizing overt and silent aspiration, verifying that the ordered texture is protecting the patient, and distinguishing a stable chronic dysphagia from a new or neurogenic one require the knowledge and judgment of a licensed nurse. Aspiration-risk surveillance is the core of observation and assessment for this domain.
Teaching and training
Teaching safe-swallow strategies, positioning, IDDSI preparation, and caregiver feeding technique — to patient and caregiver competence with return demonstration — is skilled teaching and training and is the dominant skilled service in home dysphagia management.
Management and evaluation of the plan of care
Evaluating whether the swallow and the protective diet are keeping the patient safe and coordinating SLP re-evaluation, diet modification, or a swallow study when they are not is skilled management and evaluation of the plan of care.
Skilled procedures
Skilled procedures in this domain are limited; the swallow screen, aspiration assessment, and the teaching and verification of safe feeding are the skilled service, delivered in coordination with speech-language pathology.
