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, measuring, and staging a wound; distinguishing healing from deterioration; and recognizing local versus spreading versus systemic infection require the knowledge and judgment of a licensed nurse. Serial measurement and trajectory interpretation are the core of observation and assessment for this domain.

Teaching and training

Teaching pressure redistribution, offloading, dressing protection, infection recognition, nutrition for healing, and compression use — to patient and caregiver competence with return demonstration — is skilled teaching and training.

Management and evaluation of the plan of care

Evaluating whether the current treatment order is producing the expected healing, and coordinating revisions to the dressing, offloading, debridement, nutrition, or specialist plan when it is not, is skilled management and evaluation of the plan of care.

Skilled procedures

Sterile or clean dressing changes, conservative or sharp debridement within scope and order, packing of undermined or tunneled wounds, and negative-pressure wound-therapy management are skilled procedures.