Question

A malnourished patient with metastatic ovarian cancer is diagnosed with an inoperable partial mechanical small bowel obstruction. She is taking small amounts of a full liquid diet by mouth, but is unable to take enough nutrition to maintain her weight. She has lost 12% of her body weight in the past 2 months. According to current Medicare guidelines, this patient's home parenteral nutrition (HPN) will be covered under which of the following circumstances?

1: The physician must write an order for the patient to be nil per os or \"nothing by mouth\"
2: Medical record must include a radiology report documenting the presence of partial small bowel obstruction
3: Medical record must document failure of an enteral tube feeding trial, or explain why an enteral feeding tube is not an option
4: No further documentation is necessary to confirm coverage

Answer 1

Medicare guidelines require documentation of the failure of an enteral tube feeding trial or an explanation of why it is not an option, for home parenteral nutrition to be covered in malnourished patients with a small bowel obstruction and metastatic cancer.

Step-by-step explanation:

According to current Medicare guidelines, home parenteral nutrition (HPN) for a malnourished patient with metastatic ovarian cancer and a partial mechanical small bowel obstruction would be covered under the circumstance where the medical record must document failure of an enteral tube feeding trial, or explain why an enteral feeding tube is not an option. This requirement ensures that all other forms of nutrition have been considered and deemed inadequate or inappropriate for the patient's condition before HPN is authorized. Documentation of a radiology report indicating the presence of partial small bowel obstruction or a physician's order for nil per os ("nothing by mouth") might support the medical necessity for HPN but does not, on its own, fulfill the criteria for Medicare coverage.