Page 89 - Medicare Benefit Policy Manual

6. Changing of catheters and collection of catheterized specimen for urinalysis and
culture;

7. Dressing changes, e.g., the most common chronic conditions that may need
dressing changes are decubitus care and gangrene;

8. Replacement and/or insertion of nasogastric tubes;

9. Removal of fecal impaction, including enemas;

10. Sputum collection for gram stain and culture, and possible acid-fast and/or fungal
stain and culture;

11. Paraffin bath therapy for hands and/or feet in rheumatoid arthritis or
osteoarthritis;

12. Teaching and training the patient for:

a. The care of colostomy and ileostomy;

b. The care of permanent tracheostomy;

c. Testing urine and care of the feet (diabetic patients only); and

d. Blood pressure monitoring.

Teaching and training services (also referred to as educational services) can be covered
only where they provide knowledge essential for the chronically ill patient’s participation
in his or her own treatment and only where they can be reasonably related to such
treatment or diagnosis. Educational services that provide more elaborate instruction than
is necessary to achieve the required level of patient education are not covered. After
essential information has been provided, the patient should be relied upon to obtain
additional information on his or her own.

C. Relation to Home Health Benefits

This coverage should not be considered as an alternative to home health benefits where
there is a participating home health agency in the area which could provide the needed
services on a timely basis. For example, two of the three services initially included under
this coverage - injections and venipuncture - are skilled nursing services that could be
covered as home health services (EKG is not a covered Home Health Agency (HHA)
service) if the patient is eligible for home health benefits and there is a home health
agency available. Thus, postpayment review of these claims will include measures to
assure that physicians and clinics do not provide a substantial number of services under
this coverage when they could otherwise have been performed by a home health agency.