Enteral Therapy Order Checklist
When ordering enteral nutrition, please provide the required documentation listed below:
- Patient Demographic Information
- Standard Written Order
- Chart notes documentation of a face-to-face evaluation with the patients stating the reason for prescribing enteral nutrition.
- i.e. Physicians note, dietitian/speech therapy notes, labs, swallow study (if applicable)
Standard Written Order (SWO)
An Enteral Therapy SWO must include the following elements to be valid:
- Patient Name
- Order Date
- General description of the item
- The description can be a general description, an HCPCS code, an HCPCS code narrative, or a brand name/model number
- For equipment: In addition to the description of the base item, the SWO may include all concurrently ordered options, accessories, or additional features that are separately billed or require an upgrade code (list each separately)
- For supplies: In addition to the description of the base items, the DMEPOS order/prescription may include all concurrently ordered supplies that are separately billed (list each separately)
- Quantity to be dispensed
- Ordering physicians name or National Provider Identifier (NPI)
- Ordering practitioner
- The SWO date must be on or before the delivery date and needs to be filed prior to billing.
Chart Notes Should Include the Following:
The patient has a permanent (at least three months) impairment due to:
- Non-function or disease of the structures that normally permit food to reach the small bowel; or
- A disease of a small bowel which impairs digestion and absorption of an oral diet.
- The patient requires tube feedings to maintain weight and strength commensurate with the patient’s overall health status. Adequate nutrition is not possible through dietary adjustment and/or oral supplements
- The nutrition is being provided via a tube in the stomach or small intestine (the beneficiary is not drinking the nutrient)
- The practitioner’s signature on the medical records meetings
Claims for enteral nutritional pumps
The medical record contains documentation that justifies the use of a pump:
- Gravity feeding is not satisfactory if due to reflux / aspiration; severe diarrhea or
- Dumping syndrome; or
- Administration rate less than 100 ml/hr; or
- Blood glucose fluctuations; or
- Circulatory overload; or
- Gastrostomy/jejunostomy tube used for feeding
Claims for Special Nutrient Formulas (B4149, B4153, B4154, B4155, B4157, B4161, & B4162)
The medical record specifies why a standard formula cannot be used to meet the beneficiary’s metabolic needs. (The medical record may include other formulas tried and failed or considered and ruled out. Note: A diagnosis alone is not sufficient to support the medical need for a specialty formula.)
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Lincare wants to make it as easy and efficient as possible to order your prescriptions.
- Send orders via Electronic Ordering Platforms that include build-in documentation packages without the need of paper.
- Send via fax to your local Lincare Center
