This module maps to the four Medicare skilled-nursing categories. Document the one(s) that apply this visit in coverage language.
Observation and assessment
Interpreting a glucose pattern against individualized targets, recognizing impending hypo- or hyperglycemic decompensation, screening the diabetic foot, and surveilling thyroid and adrenal status require the knowledge and judgment of a licensed nurse. Serial pattern interpretation and decompensation surveillance are the core of observation and assessment for this domain.
Teaching and training
Teaching glucose monitoring, insulin and pump technique, hypoglycemia rescue including glucagon, sick-day rules, foot care, and medication management — to patient and caregiver competence with return demonstration — is skilled teaching and training and is the dominant skilled service in new or unstable diabetes.
Management and evaluation of the plan of care
Evaluating whether the regimen is keeping glucose within the individualized target and coordinating insulin, oral-agent, thyroid, or steroid adjustments when it is not is skilled management and evaluation of the plan of care.
Skilled procedures
Skilled procedures in this domain include capillary glucose testing, insulin administration and pump and sensor management per order, and glucagon administration; most management is delivered through skilled assessment and teaching.
