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Q: How can coding intravenous (IV) medications (item P1ac) that a resident received in the hospital qualify that resident for Medicare Part A in the nursing home? We did not administer the IVs at our nursing facility.

Julia's PPS Chat, March 15, 2006

A: The updated Resident Assessment Instrument (RAI) User's Manual discusses the coding of this item on page 3-182. It states that IV medications "may be received by a nursing facility resident either at the facility, at a hospital as an outpatient, or as an inpatient, etc." It also states not to include IV medications given only during dialysis or chemotherapy, or provided during a surgical or diagnostic procedure and the immediate post-operative or post-procedure recovery period.

Therefore, after determining your assessment reference date, you can count back 14 days and include IV medications received in the hospital if they were administered during the 14-day lookback period. Based upon the resident's activities of daily living score, IV medication can place a resident into either the extensive services or special care RUG category.

An important concept to keep in mind when considering services not provided at your facility is the skilled care need for monitoring and observation when the resident is discharged from the hospital. For example, if a resident was receiving IV antibiotics at the hospital and was admitted to your nursing home, the staff must monitor that resident closely for a possible return of the infection, side effects of the antibiotic therapy, and his or her hydration status.

Always closely review the RAI User's Manual for the lookback period and whether services received prior to admission can be coded. Code items that did occur in the hospital per the RAI manual instructions only if the services were within your assessment period.

Until we chat again about Medicare Part A coverage-