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December 2016 Texas Medicaid Provider Procedures Manual

Home Health Nursing and Private Duty Nursing Services Handbook : 3 Home Health Skilled Nursing and Home Health Aide Services : 3.5 * Home Health SN and HHA Procedure Billing and Limitations : 3.5.1 * Skilled Nursing Visit for TPN Education

3.5.1
The nurse providing the intermittent SN visit for TPN services will only be reimbursed for time spent delivering client or family instruction and for direct client TPN services. The services delivered must be documented in the client’s record.
PDN and SN should not be routinely performed on the same date during the same time period.
PDN and SN will not be considered for reimbursement when the services are performed on the same date during the same time period without prior authorization approval.
If the SN visit for TPN education occurs during a time period when the PDN provider is caring for the client, both the PDN provider and the nurse educator must document in the client’s medical record the skilled services individually provided, including but not limited to:
Both the intermittent SN visit and the PDN services provided during the same time period may be recouped if the documentation does not support the medical necessity of each service provided.
A skilled nursing visit for TPN education is not allowable in a PPECC setting.

Texas Medicaid & Healthcare Partnership
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