Communication assessment and the accommodation it drives qualify as skilled nursing under the Medicare coverage categories below, and they underpin valid teaching and consent. The note must connect skilled need to the diagnosis and the specific risk.
Observation and assessment
The patient's communication ability has a reasonable potential to affect safety and care, requiring skilled observation to identify barriers and the need to modify the approach. Recognizing aphasia, low health literacy, or an interpreter need and judging its impact on safety and consent require nursing judgment.
Teaching and training
All teaching depends on effective communication; adapting instruction to the patient's communication needs and verifying comprehension 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 ensure communication accommodations are in place so that care is understood and safe, management and evaluation of the plan of care is itself a skilled service.
Skilled procedures
For example, setting up and validating an augmentative or alternative communication strategy where performed.
