Billing Alert.

Q: If a resident on enteral feedings starts out on the gravity method of administration but later moves to the pump method, how does that affect the certificate of medical necessity currently on file with the durable medical-equipment regional carrier (DMERC)?

A: When the administration method changes to the pump method, check "revised" on the certification type on the certificate of medical necessity (CMN). Submit the revised CMN with the first claim that includes the pump rental charge. Follow these steps any time the administration method changes and requires the use of a pump, whether the previous method was the gravity or syringe method. Switching to the pump method is medically necessary if residents experience complications associated with gravity- or syringe-feeding methods. Be sure to include documentation on the CMN to support medical justification for the need for the pump method of administration. Otherwise, the carrier will deny the charge for pump rental as not medically necessary.

From Billing Alert for Long-Term Care by Lee Heinbaugh, consultant, PMG, LLC (Cleveland), published by HCPro, Inc. (www.hcpro.com). Nursing Homes/Long Term Care Management bears no responsibility for the opinions/advice contained herein.