Q: Regarding tube feeding, I have a resident who resides in a SNF, she receives only flushes, no nutrition via PEG tube. She was skilled for a tube in the past (2013), but has not received any nutrition for a year; does she qualify for another benefit period? She is still receiving flushes with occasional feeding.
A: Once a resident no longer has a skilled PEG tube (I.e., less than 26% of the calories and less than 501 cc of fluid go through the tube), then billing, via the UB-04 occurrence code 22, needs to notify the MAC of this change and the date. The HETs file (formerly CWF) will count 60 days from the date of the change if no other skilled services are being provided. After the 60 day period of wellness is complete, the beneficiary will have a new benefit period available for use for a new skilled stay after a new 3-day qualifying stay.