>>Q: Can you tell me where in the Medicare Manual I can find the indication that, if a wound and its treatment does not change in three weeks, it would be considered chronic?

A: You won't find anything like that in the home health Medicare Manual. There are two references to three weeks. 1) If there are no changes in the plan of care for three weeks, the patient's condition could be considered to be stable and observation and assessment could cease to be a skilled service. 2) If the patient is receiving daily skilled nursing visits as the only skilled service and the care will last longer than three weeks, there must be a finite date when daily visits will end.

You also won't find any discussion about chronic care. §205.4 says that the patient's need for care is based on the “patient's unique condition and individual circumstances without regard to whether the condition is acute, chronic, terminal, or expected to extend over a long period of time. In addition, skilled care may ... be necessary for patients whose condition is stable.”

So, let's put that all together. If the wound care procedure were not skilled but the patient qualified for coverage through a need for observation and assessment of the wound, and there were no changes in the wound or treatment for three weeks, the patient might not qualify for ongoing coverage. A patient with a chronic wound that requires skilled nursing visits could qualify for ongoing coverage. In some cases, skilled care keeps the wound from deteriorating. Evaluate each unique situation against the coverage criteria and make an individual decision.

Twice a month, Homecare Q&A answers tough questions. Learn more about this newsletter at — http://www.beaconhealth.org/Merchant2/merchant.mvc?Screen=PROD&Store_Code=BH&Product_Code=33-580-00

Beacon Health “Ask an Expert,” August 2004
©2004 Beacon Resource Group, Inc.

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