Nutritional assessment and management qualify as skilled nursing under the Medicare coverage categories below. The note must connect skilled need to the diagnosis and the specific risk; a generic claim does not survive review.
Observation and assessment
The patient's nutritional status has a reasonable potential for change requiring skilled observation to identify the need to modify treatment. Screening malnutrition risk against the weight trend, recognizing therapeutic-diet intolerance, and detecting enteral complications require nursing judgment.
Teaching and training
Complex therapeutic diets, strategies to improve intake, and enteral feeding and site care require skilled instruction with reinforcement to mastery.
Management and evaluation of the plan of care
When the overall condition and the complexity of the unskilled services require a registered nurse to ensure the unskilled care achieves its purpose and to promote medical safety and recovery, management and evaluation of the plan of care is itself a skilled service.
Skilled procedures
For example, enteral-tube management and feeding administration and site care where performed.
