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December 2016 Texas Medicaid Provider Procedures Manual

Home Health Nursing and Private Duty Nursing Services Handbook : 4 Private Duty Nursing (PDN) Services - CCP : 4.1 * Services, Benefits, Limitations, and Prior Authorization : 4.1.5 Procedure Codes and Limitations : PDN Provided During a Skilled Nursing Visit for TPN Administration Education
For clients who are receiving PDN services who also require TPN administration education, intermittent SN visits may be separately reimbursed when the SN services are for the client or caregiver training in TPN administration.
Refer to:
Subsection 3.3, “* Home Health Skilled Nursing and Home Health Aide Services Providers” in this handbook for detailed information about SN benefits.
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.
Intermittent SN visits for clients who receive PDN and who require TPN administration education may be considered for separate prior authorization if:
The SN services may be prior authorized only for the client and caregiver who will be trained in TPN administration.
Clients whose only SN need is the provision of education for self-administration of prescribed subcutaneous (SQ), intramuscular (IM), or intravenous (IV) injections will not qualify for PDN services.
Nursing hours for the sole purpose of providing education to the client and caregiver may be considered through intermittent home health SN visits.

Texas Medicaid & Healthcare Partnership
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