CHAPTER 6 BOX 6.4 Medicare Reimbursement Criteria for Home Parenteral Nutrition15


Patient’s condition must require parenteral nutrition (PN) for long and indefinite duration. Permanent dysfunction of the gastrointestinal tract:


ƒ Condition involving the small intestine and/ or its exocrine glands that significantly impairs absorption


ƒ Motility disorder of the stomach and/ or intestine that impairs nutrient transportation and absorption


Enteral nutrition intolerance or the use of enteral nutrition has been ruled out due to gastrointestinal tract dysfunction.


Specific macronutrient requirements: ƒ Total energy: 20 to 35 kcal/ kg/ d ƒ Protein: 0.8 to 2.0 g/ kg/ d ƒ Dextrose concentration: 10% or greater


ƒ Lipid use per month must not exceed the product-specific, US Food and Drug Administration–approved dosing recommendation.


ƒ Provider must document in the medical record if macronutrient requirements fall outside of these guidelines.


ƒ Provider must have seen and evaluated the patient 30 days prior to initiation of PN therapy.


Certificate of Medical Necessity


The Certificate of Medical Necessity (CMN) or DME Information Form must be completed to document the necessity of HPN equipment and services. The document contains 4 sections—sections A and C are completed by the supplier, and sections B and D are completed by the physician. The DME supplier is responsible for signing the completed document. The form is completed at initiation of HPN and each time the PN orders change.16,17


The


form can be found on the CMS Medicare website (www.cms.gov). Box 6.5 lists the type of information required to complete the CMN.16,17


RDNs can


contribute to this document by providing comprehensive documentation of the patient’s nutrition assessment.


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