Respiratory home-health services 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 pulmonary condition has a reasonable potential for exacerbation or complication requiring skilled observation to identify the need to modify treatment or obtain additional medical care. Distinguishing baseline chronic lung sounds from early infection or decompensation, and detecting falling oxygenation, requires nursing judgment.
Teaching and training
Complex inhaler, nebulizer, and oxygen regimens and written action plans 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 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, sputum collection and tracheostomy or airway care where applicable.
