4.4 Covered skilled procedures
Used when a Chapter 8 direct skilled procedure is performed. The procedure itself supports a covered day when it is required and delivered by (or under the supervision of) licensed personnel. Representative procedures and their model note:
Procedure | What the daily note proves |
|---|---|
IV / IM medication or IV feeding | The medication/fluid, the route and site, the administration and monitoring, and the response — a covered skilled service requiring licensed administration |
Enteral feeding (at threshold) | The formula, rate, tolerance, residual per policy, and site care — coverage requires the volume/caloric thresholds be met and documented |
Tracheostomy / nasopharyngeal aspiration | The suctioning, secretion characteristics, airway assessment, and tolerance — a covered skilled procedure |
Sterile / complex wound care | The ordered technique, the wound assessment and measurements, and the healing trajectory (route detail to the Skin reference) |
Catheter insertion / irrigation / replacement | The procedure, sterile technique, output, and the documented medical indication for the catheter |
New-ostomy care (early post-op) | The care, stoma/peristomal assessment, and the teaching toward independence |
Isolation for an active infectious process | The precautions, the active infection requiring them, and the skilled monitoring |
Model daily note — skilled procedure (IV antibiotic) |
|---|
Day 3 of IV ceftriaxone for a complicated UTI. Skilled procedure: 1 g IV administered via the midline over 30 minutes per order, site without erythema/infiltration, line flushed per protocol; tolerated without reaction. Assessed the infection response — afebrile, urine clearing, WBC trending down per the last lab. Licensed administration and monitoring required for the IV route and for early recognition of a reaction or line complication; a daily covered skilled service that, as a practical matter, requires SNF-level delivery. Supports the Section N antibiotic day and Section O IV-medication item; ties to the infection care-plan goal. |